Podcasts about Spasticity

Dr. Deb Muth 00:00:09 Hi there, how are you? Bob Miller 00:00:10 Excellent! Pedaling as fast as humanly possible, but doing okay. Dr. Deb Muth 00:00:14 Good, good. Well, I’m looking forward to our conversation today. This should be amazing. Bob Miller 00:00:20 Yeah, it should be a lot of fun. Dr. Deb Muth 00:00:22 Yeah, anything that’s off-limits for you in, our conversation? Bob Miller 00:00:28 No. Dr. Deb Muth 00:00:29 Okay, anything you want me to make sure we cover for you? Bob Miller 00:00:33 Well, I mean, is it okay if we put a little plug-in for our software? Dr. Deb Muth 00:00:35 Absolutely. Bob Miller 00:00:36 Yeah. Dr. Deb Muth 00:00:37 Absolutely. Bob Miller 00:00:36 Yeah. Dr. Deb Muth 00:00:37 Absolutely. Bob Miller 00:00:38 Hey, can we… can we do a screen share? Yes, we can. Yeah, because I want to show you some maps, and… Dr. Deb Muth 00:00:43 Okay. Things like that, yeah, so… Perfect. So just let me know when you want to do screen share. Bob Miller 00:00:48 Okay. Dr. Deb Muth 00:00:49 And yeah, feel free to plug your software wherever you want to. Bob Miller 00:00:53 Okay, well, good. Let me pull up a, a slide for that, and give me one second, I just want to shut the door to my office to get the noise down. Dr. Deb Muth 00:01:01 No worries. Bob Miller 00:01:16 And, how should I refer to you? Dr. Debb? Dr. Muth, what do you like? Dr. Deb Muth 00:01:18 Dr. Deb is great, or Deb, either way, I’m pretty informal, so… Bob Miller 00:01:22 Yeah, and… Bob is fine for me. Okay. Yeah. Yeah, there you go. Why people feel like they need this, son. Special name, it’s like, seriously. Dr. Deb Muth 00:01:33 Right? I agree. Bob Miller 00:01:35 When I work with my clients, it’s like, Dr. Millison, just, just bop, just, just bop. Dr. Deb Muth 00:01:41 Yep, that’s how I am, too. Just call me Deb, it’s good. Dr. Deb Muth 00:01:44 They feel a little awkward with that, you know? They’re not used to that, but… Bob Miller 00:01:48 Alright. And you’re a naturopath, medical doctor. Dr. Deb Muth 00:01:52 A nastropathic doctor and a nurse practitioner. Oh, nice. Yeah, so I got the best of both worlds, right? Bob Miller 00:01:58 Yeah, damn. Okay. Alright, so here we go… There we go. Alright, so I got that ready, and then I will do a, I will do a screen share. I think you’re gonna really, appreciate what we’ve come up with. We’ve come up with the concept of, Cellular CPR. Dr. Deb Muth 00:02:23 Oh, nice! Bob Miller 00:02:24 And that is, construct the cell membrane, Protect the cell membrane. And restore it if it’s damaged. Dr. Deb Muth 00:02:32 Love that. Bob Miller 00:02:34 I love that. Yeah, so that’s what we’re focusing on, and then how, You know, we want to get to the point that, you know, most people think of genetics, they think of, like, 23andMe or Ancestry. Dr. Deb Muth 00:02:44 Yeah. Bob Miller 00:02:45 And then you have the professional geneticists who are looking at, you know, odd things that could create a disease. We’re looking at functional genomics. Dr. Deb Muth 00:02:54 Which is so much better. Bob Miller 00:02:56 Yeah. Are you familiar with what we do here, or… Dr. Deb Muth 00:02:58 A little bit, a little bit. So, it’ll be new to me, too, so I’m excited. Bob Miller 00:03:03 And how much time do we have? Dr. Deb Muth 00:03:04 We have an hour, give or take a little bit on either side. Do you have a hard stop anywhere? Bob Miller 00:03:10 No, no, I put a, I moved my clients around, and I don’t have anybody till, 3.30, so we’re good. Okay. Dr. Deb Muth 00:03:16 Perfect. Alright. Bob Miller 00:03:18 It’s like we’re getting started early as well, so… Dr. Deb Muth 00:03:19 Yeah, we’re getting started a little bit early, so that’s good. Bob Miller 00:03:22 Yeah, I just got my office cleaned up, so… Dr. Deb Muth 00:03:23 Okay, good. All right, are you all set to get started? Bob Miller 00:03:28 I’m good to go, my friend. Dr. Deb Muth 00:03:29 I’m gonna just record a little intro and a little bit of a, hook for people, and then we’ll get started. I’ll ask you to kind of tell us a little bit about yourself, and then we’ll just take this conversation wherever it’s supposed to go. Bob Miller 00:03:39 Okay, you got it. Dr. Deb Muth 00:03:40 Alright, sounds good. So what if the reason you’re not healing isn’t your diet, your supplements, or your labs, but it’s actually your genes? Dr. Bob Miller is uncovering how genetic variants, when combined with modern toxins, explain why some of us stay sick no matter what we try. Today, we’re talking genetic pathways, detox blocks, and the new science every wellness warrior needs to know. Welcome back to Let’s Talk Wellness Now, the show where we uncover the root causes of chronic illness, exploring cutting-edge regenerative medicine, and empower you to heal from the inside out. I’m Dr. Deb, your medical detective, and today, our guest, Dr. Bob Miller, is a true pioneer in functional genomics. He’s a board-certified traditional naturopath and the founder of Neutrogenetic Research Institute. And he’s the leading groundbreaking research on how genetic variants influence chronic illness, inflammation, and detoxification. His work has been recognized on international stages, uncovering links between genetic expression and conditions like Lyme disease, mast cell activation, or MCAS, and mitochondrial dysfunction. I’m so excited to talk to Dr. Bob today. He is gonna reveal some things that even I don’t know about, so I’m excited to learn alongside of you guys. So… Dr. Bob, let’s get started. Tell us a little bit about yourself, and kind of how you got on this journey. Bob Miller 00:05:04 Well, that’s, that’s interesting. I was sort of like a mid-career coming to the natural health field, because in my early 30s, I found myself with a severe case of ulcerative colitis. Bob Miller 00:05:15 And I was in the hospital for 21 days. probably within hours of death, pleading to death. And they told me I’ve got one option, and that is cut out the colon and wear a bag. Didn’t sound like a lot of fun. Dr. Deb Muth 00:05:27 Not an option I would want. Bob Miller 00:05:29 So, you know, the medical folks wasn’t real happy with me, but I said, yeah, I’d like to explore some alternative things.Never thinking that I’d get into this field, and then I just, you know, worked with some herbalists and things that I found absolutely fascinating. So, that’s how I got into this around 30 years ago. And, haven’t looked back since, and just having a… having a blast as we now move into how our genetics impacts things. So, that’s what we’re gonna… that’s what we’re gonna talk about today. Dr. Deb Muth 00:05:58 I’m excited to talk about this genetic thing. When you started over 30 years ago, what kind of patience and problems first inspired you to dig deeper into that root cause healing and kind of get into the genetic piece of it? Bob Miller 00:06:10 Sure. Well, you know, as a… now, I’m in a part of the country called Lancaster County, Pennsylvania, where there’s a lot of Amish and Mennonite, and they gravitate towards these things.So, this is their first thing to do, and that doesn’t work, then they’ll go other routes. So, you know, back then, we just saw typical, you know, a little tired, constipation. You know, a little bit of fatigue, arthritis, those kind of things. But things have changed dramatically over the years, as people are now getting more chronically sick. You know, it’s worse than it’s ever been. And what we’re finding is the, the culprits Primarily is mold exposure and Lyme disease. When people get those two together, they’re just… it’s an inflammatory cascade that nobody can seem to unravel. So that’s where we spend a lot of our time. And we’re also spending a lot of time looking at mental health, like ADD, ADHD. And, we give… this year I’ll be speaking at three autism conferences. And we can dig into that a little bit as to why we think we’re seeing such a dramatic increase. And aside from autism, that used to be 1 out of 1,000, now it’s 1 out of 33, or 23. You know, we’re also seeing dramatic increases in ADD, ADHD. People are stressed out. And today, I think we’ll have the time to actually go through and show how environmental factors combine with genetics to cause that to happen. So we’ll… we should have a fun visit here today. And today, I think we’ll have the time to actually go through and show how environmental factors combine with genetics to cause that to happen. So we’ll… we should have a fun visit here today. Dr. Deb Muth 00:07:37 This should be a fun visit. We can cover lots of topics. I am so excited. So, you founded Nutri Genetic Research Institute in 2015. What did you hope to accomplish, and what kind of surprised you in your findings so far about that? Bob Miller 00:07:51 Well, you know, let’s back up at what, you know, genetics is used for. Everybody’s familiar with 23andMe and Ancestry that, you know, tells you where your ancestors came from. Then you have your professional geneticists. I mean, these are people with a degree in genetics. And they’ll look for, you know, very odd sort of things that are prone to relate to a disease. So there are disease-related genetics. Well, in functional, we don’t look at either of those. We look at For example, how you’re breaking down your fats and utilizing them. How you’re recycling your glutathione. How you might be handling your iron. And none of those are disease-causing on their own.And none of those are disease-causing on their own. But when they pile up on you, and then combine that with environmental factors, that’s when things start to go south on us. So, that’s what we’re doing, we’re looking at patterns. And our first foray into this was, we did studies on Lyme disease. And our first foray into this was, we did studies on Lyme disease. So, we looked at, like, I think 50 people with Lyme disease. We looked at their genome. So, we looked at, like, I think 50 people with Lyme disease. We looked at their genome. And we found patterns that were more evident in those with Lyme. Now, this doesn’t… these genetics don’t mean you get Lyme, it just means if you get Lyme, you react worse to it. And we found patterns that were more evident in those with Lyme. Now, this doesn’t… these genetics don’t mean you get Lyme, it just means if you get Lyme, you react worse to it. So, as you know, some people get Lyme, they go on a round of antibiotics, and they’re done. So, as you know, some people get Lyme, they go on a round of antibiotics, and they’re done. Others have a little more struggle, and then others are struggling terribly for years. So there’s an old adage of genetics loads the gun, environment pulls the trigger. Dr. Deb Muth 00:09:14 Yeah, that is so true, and I think when we’re talking about Lyme and mold and things like that, we forget sometimes that our genetics can predispose us to be more sensitive to those things, and if we have genetic pathways where we don’t clear things properly, it’s harder for us to get them out of the body. And then you add on that whole rain barrel effect that we’ve always used as a functional medicine term, right? If the barrel’s half full, you’re okay. If it’s full, and now it’s spilling over, it’s a bigger problem. Have you guys found, too, that some of these environmental things actually are changing the genetics of people, or how they’re processing their own genetics? Bob Miller 00:09:53 Well, let’s go back to, Genetics 101. But we’ll go back a little bit further. So, what an interesting mechanism, what a miracle the body is. Bob Miller 00:10:03 Fats, carbohydrates, proteins, drink water, breathe air, expose the sunlight, and somehow everything gets made. I mean, when you just step back and think about that, it’s like, It’s pretty darn amazing. Dr. Deb Muth 00:10:15 I always tell women, you know, the fact that we get pregnant and we have healthy pregnancies and births is a miracle, because if we had to try to control that, that wouldn’t work so well. Bob Miller 00:10:25 Right. Well, that’s another miracle. These microscopic sperm and egg, human being, 9 months later, it’s like. But even inside of us. We are making our hair, our skin, our nails, our blood vessels, our ATP, our energy, it’s all being created. Well, that gets created by enzymes. So, enzymes take one substance, combine it with something else, and make something new. Then another enzyme comes along and does the same thing. Your DNA is the instructions on how to make the enzymes. So, when we are conceived. If it’s a, if it’s a female, of course, it’s the XX, the two chromosomes. You know, we’ve… everybody’s seen those… the genetics that… Listed pair. So, if it’s a female, the father donated the X enzyme. And the mother has no choice but to give the eggs, so that’s female. If the father donates the Y, you have a male that’s in chromosome number 1. Then 2 through 23 is the rest of the instructions on how to make enzymes. So, what can happen? We can get what are called SNPs, single nucleotide polymorphisms. And SNPs just mean that the instructions to make the enzyme’s not quite as good. So, if one parent gives a SNP on the making of an enzyme, The enzyme’s fine. It works. But, general rule of thumb, It may only work at 70-80% of efficiency. Now, a good analogy is think of an 8-cylinder and a 6-cylinder car. If parents give you good information, that’s like having an 8-cylinder car. If one parent gives you that snip, it’s like having a 6-cylinder car. Now, is a 6-cylinder car a fine car? Sure. It’ll get you from point A to point B, but it’s just going to have the power of an 8-cylinder. Then if both parents give you a SNP on the same enzyme, it may be 30-40%, and that’s like having a 4-cylinder car. Sits in the driveway, looks the same, puts gas in it, everything. But if you’ve got a 4-cylinder car. Probably not a good idea to go cross-country pulling a trailer behind you up and down mountains. Dr. Deb Muth 00:12:29 This is true. Bob Miller 00:12:32 So… We can get an 8-cylinder, 6-cylinder, or 4-cylinder enzyme. Now, if it’s not under a lot of stress, if that 4-cylinder car is just taking you to the bank and the grocery store. It’s just as good as an 8-cylinder car. But if you gotta pull that trailer, and there’s a lot of stress on it, being mountains, it’s gonna struggle. Now, there’s one other little caveat to this, and that is some genetic mutations are gain-of-function. They actually work faster. Now, we have enzymes that do all kinds of things. We have enzymes that make and recycle our antioxidants, but we also have enzymes that make inflammation. No, that’s a good thing, because if we get a virus or bacteria, if you didn’t make inflammation to kill it, well, we’d all die of infection. So, you know, we tend to think of free radicals as bad, antioxidants as good. They both play an important role. But interestingly, some of the major enzymes that make inflammation, they can be overactive. They can be turbocharged. And when they’re stimulated by environmental toxins, they overreact. Bob Miller 00:13:40 And therein lies the problem. When they overreact, we have a problem. Bob Miller 00:13:46 So, if we have genes that overreact when stimulated. And then the enzymes that take care of inflammation are underactive. Then you’re gonna be more inflamed. You know, the majority of people that, you know, come for functional medicine Or naturopathic help, or… Inflammation that they can’t seem to get under control. Dr. Deb Muth 00:14:06 Right. Bob Miller 00:14:07 And we will be, you know, during this hour, we’re going to look at some of the pathways that make that happen. So, what we can do then, we can’t change our genetics. When you’re conceived, that’s the hand you’re dealt. When your life would be over, if someone would take some tissue and measure, it’d be exactly the same as conception. Does it change. Bob Miller 00:14:28 The enzyme’s ability to do its job may be compromised. Because remember I said there’s a, the enzyme takes a cofactor. So an enzyme takes substance A, cofactor, make substance B. Well, if that cofactor’s not there, the enzyme’s not going to work either. So, you could have an 8-cylinder car, and if there’s no gas in it, it’s not going anywhere. So… It’s the strength of the enzyme, it’s the cofactor to do the A to B conversion. And that’s what we’re going to get into. So, many people say, well, where did these SNPs come from? Nobody knows for sure. Sometimes they’re what’s just called de novo, when the sperm and egg go together, the instructions get mixed up a little bit. We do believe a lot of it came from a long time ago, when we were almost wiped out by sexually transmitted diseases. And those STDs were altering the genes when the conception, in other words, when the sperm went into the egg, the STDs were interfering. And causing the problem, so… I often joke, if you want to blame somebody. Blame your great-great-great-great-great-great-great-grandparents for, being a bit promiscuous, so… Dr. Deb Muth 00:15:31 Yeah, for being… having a little too much fun, right? Bob Miller 00:15:35 So, we don’t know for sure, but, you know, there are some that, But most of the SNPs that we get inherit from our parents. So, if you look at a child. And you look at the SNPs. 99.9% of the time, it came from one of the parents. Dr. Deb Muth 00:15:50 In identical twins, do they have the exact same identical makeup? Bob Miller 00:15:54 Yep, Dr. Deb Muth 00:15:56 But not in fraternal twins, correct? Bob Miller 00:15:59 No, no, those could be different, Jeff. Dr. Deb Muth 00:16:00 It could be different because they have different sacs, they’re not sharing that same genetic makeup. Bob Miller 00:16:04 Yeah, so keep in mind, both your mother and your father have, you know, the two And so you get one from one parent, one from another. Dr. Deb Muth 00:16:13 So… Bob Miller 00:16:14 Interesting situation. I had, 3, 3 boys. And, we were looking at an enzyme related to breaking down oxalates. Now, the mother and father each had one SNP, and that’s called heterozygous. Three boys, and they all come together, they’re Amish boys, they’re a lot of fun. And I looked at their genomes, and the one boy didn’t have any SNPs at all. And one had won. And the other one had two. Dr. Deb Muth 00:16:41 Interesting. Bob Miller 00:16:42 So, we don’t quite know how these things get handed off, but with the parents each having one, you could have a child with none, one, or two. So, the one, his ability to break down oxalates, which is fine. The other one was slightly impaired, and the other one was dramatically impaired. So, you can have 3 children, and it all depends what the parents have. Now, if a parent has a homozygous, or 2 copies. And the other parent has nothing. Every child will have one. Okay. If both parents are homozygous, that they both have two, Every child will have two. Dr. Deb Muth 00:17:19 too. Bob Miller 00:17:20 Yes, so that’s the way it works, but, you know, but it’s somewhat rare that both parents are homozygous on an enzyme, but it can happen. Dr. Deb Muth 00:17:27 Do we think that infections today, like Lyme disease or mold exposure, things like that, if the parent, the woman, primarily, I’m thinking, is pregnant, and she actively has these infections. Can those infections affect the genetics, kind of like a past sexual transmission did where we thought back in the day? Bob Miller 00:17:47 Yeah, I… I mean, I’m not that much of a geneticist to answer that for sure, but my thought would be no, that at conception, the pattern’s made. Dr. Deb Muth 00:17:55 Okay. And then that’s… that’s the hand you’re dealt. Bob Miller 00:17:58 Yeah. So, I tell people we have good news and bad news. The good news is we can compensate for the weakness. The bad news is we can compensate for the weakness. Dr. Deb Muth 00:18:09 That is so very true. Bob Miller 00:18:11 Yeah, we can’t, because I often get asked, so we’ll do some things now, and we’ll check my genes again, and they’ll be better. It’s like, nope. Dr. Deb Muth 00:18:18 Oh, – – Bob Miller 00:18:19 You gotta play the hands you’re dealt, so… Dr. Deb Muth 00:18:21 That’s right. Bob Miller 00:18:22 You can test your genetics… if you’re looking at the same enzyme, you can test it every year. It’s not gonna change. It’s like the blueprint. Dr. Deb Muth 00:18:30 It’s good and bad, right? It’s the one test you only have to do once in your lifetime. Bob Miller 00:18:34 No, unless, you know, like, our. Dr. Deb Muth 00:18:36 All the time. Bob Miller 00:18:37 Yeah, now our test looks at, called the Functional Genomic Analysis Test of your genomic Resource. We look at 220,000 steps. Dr. Deb Muth 00:18:46 Wow, that’s a lot. Bob Miller 00:18:47 That’s not all of them. Dr. Deb Muth 00:18:49 Right. Bob Miller 00:18:50 So, maybe in the next year, we’re gonna come out with our third version of the chip. And then, if someone wants to get those new things that weren’t on it, they’d have to repeat. But whatever we measured is gonna stay the same. Dr. Deb Muth 00:19:03 That’s a lot of SNPs to look at. Bob Miller 00:19:05 Keeps us busy. Dr. Deb Muth 00:19:06 But there’s still, but there’s still SNPs that we. Bob Miller 00:19:09 That we’d like to have that we don’t have, so… Bob Miller 00:19:11 We started out with version 1 on our genetic test, then we worked with version 2, and we’re already compiling a list of what version 3 would look like. So if somebody has our version 2, And we’re saying, you know what, it’d be nice if we could see these, well, then you’d repeat, but it won’t change what you already know, so… Dr. Deb Muth 00:19:29 Got it, got it. So, when you started out, and you started looking at the research of Lyme disease and chronic infections, which detox pathways are most important for people who struggle with those conditions? Bob Miller 00:19:43 Okay. You know what might make sense as we do a screen share, and I’ll actually show you the pathway. Does that make sense? Bob Miller 00:19:48 Alright, so… let’s see if I… let me just press the share… Dr. Deb Muth 00:19:52 Yep, you should just be able to press share. Bob Miller 00:19:54 And… number 2. Okay. Are we seeing the screen there? Bob Miller 00:20:01 Okay. Dr. Deb Muth 00:20:02 So, this is a map that we made. Bob Miller 00:20:05 And by the way, this is not… All-inclusive of all the things we look at, but we believe this is a core issue. So, where we’re going to start here, there’s something called the microglia. And the microglia are glial cells. They’re in the brain and the central nervous system. And they’re very interesting little creatures, because most of the time, and this is just a drawing of what they sort of look like. Most of the time, they’re in what’s called the M2 anti-inflammatory mood. What that means, these little guys pick up dirt, debris, Recycle them. Turns on an enzyme called interleukin-10 that’s anti-inflammatory. And just kind of does general housekeeping. And just kind of does general housekeeping. However, when a trigger comes along. However, when a trigger comes along. They… it’s the same glial cell, but it moves over to a very pro-inflammatory enzyme. A pro-inflammatory glial cell. And it triggers these 3 enzymes, Actually, these four. That are pro-inflammatory. Tumor necrosis vector alpha, Interleukin-6. NF Kappa B, Inos. Now, these create inflammation. So you might think, well, why is that good? Well, if you have some foreign invader, virus, bacteria coming in, parasite. If you didn’t have these guys coming to the rescue, you would just die of infection. So, these guys are your friend unless they’re your worst enemy. Because TNFA, and we’ll show you when we actually do a demo account, TNFA can be overactive. So, in other words, it over-responds. Interleukin-6 can be overactive. And if Kappa-B can be overactive. The INOS, and I’ll explain each of these as we go through a demo, can be overactive. Now, what that means is, you’re very good at killing virus and bacteria. But this is where autoimmune disease comes in, and just inflammatory conditions. Now, this is just speculation, but we think what happened is, as you know. Thousands of years ago, we didn’t have refrigeration, we didn’t have sewer, we didn’t have pure water, and we didn’t have antibiotics. So, if you made it to 40, you were an old-timer, because everybody was dying of infection. So, what we believe happened is, by what’s called natural selection, Having these overactive. A thousand years ago was to your advantage. Dr. Deb Muth 00:22:31 Hmm. Bob Miller 00:22:32 But now… We have pure water, we have refrigeration, we have sewers, we have antibiotics. But now we have environmental factors that are stimulating them. Now it’s to our disadvantage. And we’ll talk about that a little bit as it relates to the hemochromatosis genes and maybe the G6PD. Dr. Deb Muth 00:22:48 Yep. Bob Miller 00:22:49 Now, why are we becoming so inflamed? Let’s look at the triggers. Now, one of my, favorite expressions is. I was born all the way back in 1954. Dr. Deb Muth 00:23:01 And it was a different world back then. Bob Miller 00:23:05 These are some of the triggers. And we’ll get into these, but right now, high fructose corn syrup, And the high-fat diet. High fructose corn syrup only came about in 1968. So now we’re being exposed to high fructose corn syrup. Then… we didn’t have these, these viruses like COVID. Dr. Deb Muth 00:23:26 Yeah. Bob Miller 00:23:27 Now, there’s now pretty strong evidence that COVID Was actually, you know, made as a gain of function. It’s debated, and I’m not taking an opinion on it, but there’s some people who believe Lyme disease was also a part of experimentation. Dr. Deb Muth 00:23:40 Go. Bob Miller 00:23:41 Then we have molds, and it appears as though mold is getting stronger. you know, 20 years ago, when I was seeing folks, mold wasn’t on the radar. I would say 7 out of the 10 folks we speak to today have mold problems. Yeah, 20 years ago, we talked more about mold allergy being an issue versus mold toxicity being an issue. Right. So… I know some folks are, you know, speculating what’s happening, but one of the theories out there is that EMF is strengthening mold. I don’t know if you ever heard that theory, and I don’t… Dr. Deb Muth 00:24:13 I have. Bob Miller 00:24:14 I’m not claiming it’s true, but it’s an interesting theory. Then even, you know, your black mold from water-damaged buildings. Then our air pollution is getting worse. We’re getting more toxic metals. Dr. Deb Muth 00:24:26 You know, if we have a… Bob Miller 00:24:27 You know, we’re gonna look back someday and say, what were we thinking, smearing aluminum into our armpits? The, what were we doing putting mercury in our teeth? Then, you know, glyphosate. When I was a kid, there was no glyphosate. So, all of these herbicides and pesticides. Polychlorinated biphenols, And then EMF. So, we love our cell phones, you know, and I think unless you, or in the middle of the desert, or down in a cave, you’re being exposed to EMF somewhere. So, you know, we have our cell phones with us, we have, We have Wi-Fi, the towers are everywhere. And we don’t know long-term, but we may find that this can… this creates some inflammation. And I don’t know if you get any folks, but do you have any folks that have… are they EMF sensitive? Dr. Deb Muth 00:25:16 Oh yeah, we have a whole bunch of them. Bob Miller 00:25:18 Yeah, and then if you have any TBIs, So, plenty of things here. that will stimulate into the microglia, M1. Now, you could say, well. We’re all pretty much exposed to the same thing. Why do some people get hit harder than others? So here’s where we’re gonna start. There’s an enzyme called Nrf2 and RF2. And Nrf2 is the enzyme that senses when there’s inflammation. And turns on hundreds of anti-inflammatory enzymes. We’ll show when we do the demo, you can have genetic weakness on NERF2. And NERF2 inhibits and slows down microglia M1. supports M2. Now, if it’s not complicated enough, there’s an enzyme called KEEP1. And KEEP1 inhibits NRF2. And you can actually have gain of function on keep 1, that makes Keap 1 stronger. So… A lot of the people who land on my doorstep So… A lot of the people who land on my doorstep Both parents gave a mutation on KEEP1, making it overactive. Both parents gave a mutation on KEEP1, making it overactive. Dr. Deb Muth 00:26:31 Hmm. Dr. Deb Muth 00:26:31 Hmm. Bob Miller 00:26:32 Suppressing Nrf2, nerve 2 might be weak. So, nobody’s putting the brakes on, M1. And by the same token, Nerve 2 supports M2. Then there’s a process called mTOR and autophagy. mTOR stands for mammalian tard of rapamycin, the growth of new cells. And then autophagy, taking our dead cells and recycling them. We need a balance between the two of them. If we didn’t have mTOR, the sperm and the egg would never become the baby, the baby would never become the adult, we wouldn’t make new cells. But our cells are constantly, you know, the old cells dying off. Autophagy is where we take that debris from the cell and recycle it, just like a farmer Plows the crop under at the end of the year. The dead plant then becomes the fuel for the spring, your dead cell becomes the fuel for the spring, and that’s autophagy. So we’re gonna look back someday and say, what were we thinking? We give our animals growth hormones so they get fatter faster. Oh my. So, we consume those animals, and inventory runs faster. Now, for anybody who’s, You know, maybe above 40, 45 years old. Think back when you were 12, and what did girls look like? They were primarily flat-chested little girls. Now they look like 16-year-olds. Because environmentally, we’re jacking up mTOR. So, mTOR stimulates microglia M1, suppresses microglia M2. Probably 80% of the folks we visit with. This is the part of the problem. NRF2 is weak. mTOR is strong. Environmental factors come along. And this guy gets carried away. He doesn’t do that burst and move back. Stays here. We’re calling that How environmental factors create a locked-in, pro-inflammatory. and neurotoxic phenotype. In other words, once it starts, it just keeps… Feeding upon itself. Alright, so what happens now when microglia is overactive. it triggers these 3 enzymes, TNFA, N of kappa B, And interleukin-6. Each one of these can have genetics that make them run stronger. Then it stimulates an enzyme called NLRP3, Which makes what are called inflammasomes. Now, guess what inflammasomes can be? Your best friend or your worst enemy? Because they will, if you’ve got, again, a virus or bacteria, or possibly even some bad cells in the body. They will zap them. Well, that’s good. Unless it’s overactive. Unless it’s overactive. And then what it does, through interleukin-1 beta, makes excess glutamate. And then what it does, through interleukin-1 beta, makes excess glutamate. Anxiety, gut inflammation, OCD, ADD, autism. And, you know, glutamate, we’ll talk about that a little bit, but glutamate makes you intelligent, highly motivated go-getter. but can also be excitatory. And then, look what it does. Let’s see, do I have the drawing tool here? Yes, I do. Okay. So, it comes down through here, Makes the glutamate. Comes back up through here. through the ADORA 2A enzyme, Then we’ve got a feedback loop that feeds upon itself. Then, through interleukin-18, we make histamine. and mast cells. And then through histamine receptor site number 1, we come back and spin it. And now you’ve just got this spinning feedback loop. So, the glutamate will make you anxious, the histamine will give you allergies and make you anxious. And you’re allergic to everything, and you’re feeling horrible. Now, it doesn’t end there, Dr. Dad. It then goes on to make something called gast dermins that creates pyroptosis, where it actually starts punching a hole in the cell membrane. And you’re only going to be as healthy as your cells are. Just a little background. You know, we’re made up of trillions of cells, and each one of them has what’s called a lipid bilayer, made from lipids, which comes from fats. And you’re only going to be as healthy as those membranes are. So that’s why we coined an interesting phrase. Cellular CPR. Construct the cell. Protect the cell. And restore the cell membrane. And we believe that’s going to be revolutionary in the functional medicine world. So… It’s not hard to figure out that if you start punching holes in the cell membrane, that’s not a good thing, okay? Bob Miller 00:31:22 Now… There’s an interesting molecule called NAD. Thicotide adenoside dinucleotide. And anybody who’s in the, you know, listening to the health podcasts and things, they’re… They’re, they’re learning about NAD. And I’m going to show you a chart later, all the good things that NAD does, but For the most part, it helps what’s called sirtuins. And sirtuins are quite interesting. If anybody’s looking at longevity. The sirtuins is where they’re looking at.Because sirtuins turn on good things. Turn off bad things. And I’ll show some charts on that later. So for right here, this sirtuin uses NAD, to slow down NF-kappa-B. CERT 2 uses NAD to slow down an ORP3. So, if we’ve got genetic weakness on these, or we don’t have enough NAD, We don’t hold this pathway back. Make sense? Dr. Deb Muth 00:32:24 Yeah, makes perfect sense. Bob Miller 00:32:25 Now, I’ll show this a little bit later. So, people are like, oh, well, I’m gonna start taking some NAD. Dr. Deb Muth 00:32:31 Right. Bob Miller 00:32:32 And there’s functional doctors who give NAD intravenous. It was just this morning, I was talking to a woman who said, Oh my gosh. I went and got intravenous NAD, and it took me a month to recover from that. Dr. Deb Muth 00:32:45 Hmm. Bob Miller 00:32:46 what happens is, and I’ll show this in a little more detail, there’s an enzyme called CD38, that’s stimulated by NF-kappa-B. And it takes NAD, To make intracellular calcium. that stimulates NLRP3 and actually makes things worse. So, if we have this guy upregulated, and I’ll show a chart what does that. taking NAD will make you worse. Again, when I go into the software, I’ll show you that whole pathway, so… I would encourage people, you know, just don’t go out and start taking massive amounts of NAD, you know, stick your toe in the water, see how you do. Because everything you’ve heard about, how good it is, is true, unless this guy says, oh, thank you very much, let me make more inflammation. Now, this might be part of our innate immune system, that if we have some pathogen that’s gonna kill us. By golly, we want that to happen. But if this is happening by environmental factors, Then it’s detrimental. So the immune system that protected us a thousand years ago now might be turning on us because of the environmental factors that we showed earlier. All right. Then there’s an enzyme called PARP that’s NAD-dependent, and that actually repairs strain breaks in your DNA. Now, the next thing that happens… is there’s an enzyme called NADPH oxidase that gets stimulated. and something called INOS. Now, I’m sure most people know about nitric oxide. It’s a gas that dilates your blood vessels. That’s why sometimes they’ll even give people drugs, nitroglycerin, to boost their nitric oxide. That’s why people are doing beetroots and other things to boost their nitric oxide. But there’s an OS3 enzyme that makes the nitric oxide that’s good for blood flow. But there’s an INOS That makes nitric oxide to kill pathogens. probably might be the third or fourth time I’ve said this. That’s a good thing, unless it isn’t. So, if it’s killing some pathogen, great. It was just misfiring. it combines… With superoxide that’s made by this enzyme, and makes something called peroxynitrite, which is one nasty free radical that chews you up and spits you out. So, the NOx enzyme, NADPH oxidase, uses NADPH, To make this free radical called superoxide. If we have time, we’ll get into it. NADPH is what your body needs to recycle your antioxidants.So, I coined the phrase, the NADPH steel. Where the NOX enzyme takes this very important NADPH, And rather than being useful, makes superoxide. Now, again, is that fine if you’ve got some bacteria to kill? Of course. But if it’s just chronically running, it’s just making all this chronic inflammation. Then it makes something called hydrogen peroxide. And we need to clear hydrogen peroxide by 3 enzymes, catalase, thyroid reduction. And glutathione peroxidase. If we have genetic issues on here, or we don’t have the cofactors. There’s something called the Fenton reaction, discovered in 1895 by Dr. Fenton. Where hydrogen peroxide combines with iron to make what are called hydroxyl radicals. And guess what they do? They create lipid peroxides, That damages your cell membranes. Now, again, the body’s pretty darn amazing. We have glutathione, And here’s where your body’s taking glutathione and recycling it. But look who’s needed to recycle it. NADPH. So, if this guy up here is chewing it up, We don’t recycle our glutathione. And then an enzyme called glufon peroxidase 4, Takes this damaged lipid and repairs it. So, here we’ve got this protecting, we want to protect it by not having this happen. But then we also need this guy to do the restoration. So, there’s a lot that can go wrong in here, Dr. Deb. Dr. Deb Muth 00:37:07 There’s a lot that could go wrong. And I can imagine some of my listeners are thinking that lipid peroxidase, is that the same thing as what they’re thinking of when we talk about lipids and cholesterol? Is that the same process that’s happening there? Bob Miller 00:37:22 Well, no, no, the lipids can be used to make cholesterol, but here we’re talking about where they’re going to build the cell membrane. And they’re being… and they’re being, destroyed. If anybody would like to see a visual representation of this, just go on YouTube. And type in, ferrooptosis Animation. cool little video, it’s about 3 minutes long, and it shows the lipids coming over, being oxidized, and now GPX4 fixes them, so… YouTube, Pharaoptosis Animation, cute little video. It’s just that really… Shows vividly what we’re… what we’re talking about here. Now, this is… Dr. Deb Muth 00:37:59 And so this is very common, too. Like, a lot of people do hydrogen peroxide IVs. Dr. Deb Muth 00:38:04 And so, if somebody doesn’t know their genetics, they could have a problem with doing those, just like they could doing the NADHIVs, correct? Bob Miller 00:38:13 Sure, yeah, yeah, yeah. So, I’ve talked to so many, you know, of course, the hydrogen peroxide kills pathogens. I mean, that’s what it does. So… but I’ve spoken to so many people that said. I had one client that said they’ve never been the same after having one hydrogen peroxide infusion. Dr. Deb Muth 00:38:30 Interesting. Bob Miller 00:38:31 Yeah. So… it can be… I see why people use it, because it. Bob Miller 00:38:36 pathogens, But on the other hand. And now’s a good time to speak about… I don’t have it on here, but there’s a, there’s an enzyme called the HFE gene. And that is what causes you to absorb iron. And there’s mutations in it that cause something called hemochromatosis. Were you overabsorb iron? Now, true hemochromatosis is when both parents give you a mutation. But there’s now growing evidence even a heterozygous can cause a little bit more iron absorption, not to the human chromatosis point, but overabsorption. So, if you overabsorb iron, And you have too much hydrogen peroxide that’s not cleared, All kinds of inflammation. Now, what’s happened is sometimes this inflammation Will damage the red blood cells. And some well-meaning doctor says, oh, you need some iron. And they take iron and it makes it worse. So, can’t tell you how many people I’ve said, you’ve got the overabsorption of iron, and they say, well, that can’t be right, because I’m low in iron. Well, that could be because it’s being chewed up here. Dr. Deb Muth 00:39:40 Sure. GPX1 and TXN turn it into, to water. The, catalase turns it into water and oxygen. Dr. Deb Muth 00:39:58 Now, I see a lot of my clients who have mutations or SNPs on that GPX gene, on that glutathione gene. And they really struggle to clear a lot of their toxins. Bob Miller 00:40:12 Sure. Dr. Deb Muth 00:40:14 Yeah, absolutely. Well, GPX4. Bob Miller 00:40:18 is what, repairs, but you can see GPX1 Is what uses glutathione. To turn hydrogen peroxide. So, but it all depends upon having enough glutathione. Dr. Deb Muth 00:40:30 Yeah. Bob Miller 00:40:31 Well, guess who controls making a glutathione? Dr. Deb Muth 00:40:34 Nerf 2. Bob Miller 00:40:37 So, if you have a keep one weakness, or strength to two… I’m sorry, keep one is too strong. Nrf2 is too weak. You don’t make glutathione. So, when a lot of people do that, it’s like, well, I’m gonna take glutathione. Dr. Deb Muth 00:40:51 Right. Bob Miller 00:40:52 And some do great, and some do poorly. You know, because… and I’ll show this on one of the other charts. You can see here that the, The glutathione has to be recycled. And if we don’t recycle it, it actually turns into superoxide free radical. So… NADPH are the cofactors, For taking the oxidi… here’s oxidized glutathione, here’s reduced. So, this is a good glutathione. After it does its job, you can see it becomes oxidized.We need to recycle it. Well, if we have weakness on the enzyme that does that, or a weakness in Nrf2, or not enough NADPH. The oxidized glutathione never gets recycled. So, I’ve talked to a lot of people who said, oh, glutathione made me so sick, and say, well. Dr. Deb Muth 00:41:43 Yeah. Bob Miller 00:41:44 You need it, but you need to recycle it. Dr. Deb Muth 00:41:46 Can you speak for just a brief moment, too, about MTHFR? That is a very popular gene, it’s all over social media as the major gene, but can you speak to a little bit about that, and how that fits into this whole process of things? Because it is just such a small piece. Dr. Deb Muth 00:42:04 understanding genetics. Bob Miller 00:42:06 Yeah, to be honest, it drives me nuts. Dr. Deb Muth 00:42:08 Me too. Bob Miller 00:42:11 Alright, so… You know, there are people on social media I won’t say what I think, I’ll be kind. But… But the, And, you know, they might mean well. But they talk about, if you have MTHFR and COMT and PEMT, that’s… oh my goodness, that’s horrible, and we’ll fix that for you, and you’ll be fine. Bob Miller 00:42:36 it just irritates me to no end. And it really could get anybody who’s doing this legitimately in trouble. I mean, I’m afraid someday, you know, there might be some cracking down on this kind of nonsense. Now, to answer your question about MTHFR. Dr. Deb Muth 00:42:51 I mean, it really is, but I’ll tell you what, why don’t we hold that thought until I go to another map and I can actually… Okay. Bob Miller 00:42:56 But the real… the cliff notes is the MTHFR puts a methyl group on your folate, which is needed, but it has gotten way, way, way too much attention. And people learn they have MTHFR, and they start taking a multivitamin with methylfolate, then they take a B vitamin with methylfolate. Dr. Deb Muth 00:43:13 And they’re pushing it too hard. Bob Miller 00:43:15 Yeah. So I can’t tell you how many people I’ve helped by saying, stop it. Dr. Deb Muth 00:43:20 Yeah, take less of it. Bob Miller 00:43:21 Take less of it, yeah. So, yeah. Yeah, there’s a… If somebody, say, ranked the enzymes at their level of importance, MTHFR might be 40 or 50 on a scale of 100, you know. Keep one Nerf two. big deals. Dr. Deb Muth 00:43:40 deals. Bob Miller 00:43:41 NQO1 that I didn’t even talk about yet, NQO1, takes your, NA… your NAD goes into NADH, To make electrons for the electron transport chain. you need NQ01 to bring that back. If that’s not working, and I’ll show you on the NAD map how disastrous that can be. Now, the next piece is here, and I think You know, if you talk to any school teachers and say, if you’ve taught for more than 10 years, how are the kids today? Every one of them says, more ADD, ADHD, more autism. Just look at human beings, we’ve never been so agitated. You know, everybody, and it might be a social media thing, but people take a position on something, and if anybody doesn’t share that position, they view them as the enemy. Dr. Deb Muth 00:44:29 And it’s kind of scary what’s happening to us. Bob Miller 00:44:33 So, we can’t agree to disagree anymore. We see anybody who has a differing opinion as the enemy. And, you know, there was… there’s people that didn’t have Christmas dinners together, because they had political differences, like… Dr. Deb Muth 00:44:44 Excuse me. Bob Miller 00:44:45 can’t you put your political differences aside to have Christmas together, you know? Dr. Deb Muth 00:44:49 Right? Bob Miller 00:44:50 become that, you know, no matter what your position is, and I’m not saying anyone’s right or wrong, I’m just saying. You know, in the old days, they used to say that the Republicans and Democrats in Congress would argue policy and then go have dinner together. And now everybody’s all up in arms, angry. Dr. Deb Muth 00:45:05 Yeah. Bob Miller 00:45:06 So… There’s likely multiple reasons for that. But let me show you one of them. That, you know, to what degree this is… very important, we don’t know, but I think We’re beginning to believe this is very important. So, there’s something… there’s a neurotransmitter called GABA. And God buys the don’t worry, relax, be happy. Chill. Okay. Dr. Deb Muth 00:45:31 Nobody has enough of that anymore. Bob Miller 00:45:33 Well, yeah, you’ll be surprised what I’m gonna show you. So, let me see if I can find a, Let me see if I can find the right slide here. Let me look for it here. So, there’s something called a GABA receptor site. And here you can see… This is a neuron, and this is where you, The neuron normally is excitatory. However, there’s normally low chloride in the neuron. Dr. Deb Muth 00:46:09 Hmm. Bob Miller 00:46:10 So, GABA itself is neither relaxing. For excitatory, all GABA does, it opens up what’s called a chloride channel. And then chloride, which has a negative charge, will flow into the neuron. Follow me there? Dr. Deb Muth 00:46:26 Yep. Bob Miller 00:46:27 And as it does, it changes this from a positive charge to a negative charge, And it’s relaxing. and inhibitory. Dr. Deb Muth 00:46:34 Hmm. Bob Miller 00:46:36 Now, on the other hand, there’s enzymes called NKCC1, That will push chloride in. and KCC2 that will bring chlor… oops and bring chloride out. And then there’s a sodium channel. And, sodium has a positive charge. And glutamate will push that in. So, as long as this is happening. And GABA says, receptor sites, open, chloride goes in, Chill. However, If NKCC1 Pushes extra chloride in. KCC2 doesn’t pull it out. and GABA hits the receptor site, the GABA comes flowing out, Sodium comes in, And now it’s excitatory. So Gabba didn’t change. GABA just opened the receptor site, that’s all it does. Dr. Deb Muth 00:47:33 Yeah. Bob Miller 00:47:34 But it’s the chloride balance that’s going to determine whether this is relaxing or not. Now, these are the things that go along with when they lose that KCC2 or gain NKCC1. Pain and sensitivity, burning electrical, neuropathic pain. Normal touch hurts. Sound and light sensitivity. Tinnitus can flare. Headaches and migraines. Seizure tendency. Body jolts. Spasticity, cramps, stiffness, startle reflex. Trouble falling asleep, non-restorative sleep. Anxiety, stress, reactivity, that’s what we have now. Hyperarousal, panic-like surges, irritability, racing thoughts. Brain fog, slowed processing, working memory slip-ups. Mental fatigue. Episodes of racing hearts, sweaty palms, guts on edge. Those are all the things that happen when this GABA switch occurs. Now, here’s what happens, and this is what I’m going to be presenting at an autism conference. When you have a newborn, they need that NKCC dominant to develop. By early childhood, it should… or, sorry, early adulthood. we should move over to the KCC dominant, that’s the taking the chloride out. Nice-looking 25-year-old boys, functioning very well. However, when we get microglia M1 upregulated. Because of environmental toxins, processed foods, Tylenol, aluminum. they stay in NKCC1 dominant, and there’s ADD, ADHD, Autism, the whole spectrum. because… They’ve not moved over to the… They’ve not moved over to the KCC2. And again, this is caused by… Environmental factors. Stimulating the microglia. And then, interleukin-1, interleukin-18 weakens KCC2, interleukin-1 beta, Strengthens NKCC1. high chloride. We open up the chloride channel, In Rebell Excitatory. So, I think when, When the pediatricians get ahold of this, they’re going to be very excited to know that This could be why we’re seeing such a rise, and not just autism, but ADD, ADHD, anxiety, the whole shit mess. Dr. Deb Muth 00:49:58 thing. Bob Miller 00:49:59 Yeah, so… and you can see NF-kappa-B stimulates that. These stimulate it, and I think that’s why everyone’s getting so anxious. Now, there’s a little bit more to it, and we’ll get into this when we look at some of the maps, but… The, the glutamate, Which is excitatory. will stimulate the NMDA receptor, make more glutamate, And glutamate will inhibit KCC2. And then we also need an astrocyte To, take both ammonia And glutamate, and… Turn them back into glutamine. And I’m going to talk to you a little bit about arachidenic acid, and if we have too much arachidenic acid. or TNFA is upregulated, that doesn’t happen. Ammonia goes up, and there may be multiple reasons for this, but this is a reason why some of the autistic kids do flapping. Dr. Deb Muth 00:50:49 Hmm. Bob Miller 00:50:50 Because they’re not clearing their ammonia. And you can tell if somebody has high ammonia by… they get that old person smell, you know. Dr. Deb Muth 00:51:00 Yup. Bob Miller 00:51:01 your vehicle cycle’s not taking out the, the ammonia. Now, last pathway here. There’s growing interest in mast cell activation. So, back here, we talked about peroxynitride. And that will stimulate mast cells, and those are white blood cells that are your best friend, unless they’re your worst enemy. Then it’ll make histamine. And there’s enzymes called histidine decarboxylase that’ll make more. Dr. Deb Muth 00:51:28 I’m sure everybody’s heard of DAO, the enzyme that degrades histamine. Yep. Bob Miller 00:51:31 We can have genetic weakness, we don’t make that. There’s an enzyme called histamine and methyltransferase, That, That breaks down the histamine. Then if we don’t do that, it’ll get stuck in the histamine receptor site. And then it’ll make something called, renin. Which will cause angiotensinogen to turn into angiotensin. One, that turns into angiotensin II,And that’s where people make aldosterone, where they’ll get the, The swollen ankles and high blood pressure. But interestingly, there’s an enzyme called ACE2, that takes this guy and turns it into angiotensin 1-7, Which is anti-inflammatory and also inhibits… TNFA. Now, you can have weakness on ACE2, But… and anybody’s saying, that sounds familiar? Dr. Deb Muth 00:52:25 That’s where COVID comes in, using ACE2. Bob Miller 00:52:28 And now we just found there’s literature that if you get COVID long enough, it can actually make ACE2 not be able to work as well. So look what it does. It comes down here, stimulates the NADPH oxidase, More superoxide. More peroxynitrite. And we’re on a cycle here. We’ve actually named this the Home Cycle Hypothesis, the proposed feed-forward loop. That just keeps feeding on itself. All being caused by… Primarily, The environmental factors. But hitting those who have genetic weakness the hardest. That’s why. Dr. Deb Muth 00:53:08 To the people. Bob Miller 00:53:09 Don’t live in a moldy house. One person is sick as can be, and the other person says, well, you must be imagining things, because I don’t feel anything. Dr. Deb Muth Yeah. Same thing with long haul, right? Two people can both get sick, one gets sick and never seems to recover, and somebody else gets sick, and they have absolutely no problems with it at all. Bob Miller 00:53:30 Sure. Well, think about it, if you get COVID, and ACE2 is weak, and some of this other stuff is going on. This thing just starts feeding upon itself. Dr. Deb Muth 00:53:38 Keep creating more inflammation, more complications, nothing’s calming down. Bob Miller 00:53:43 Yeah. Now, you, you ask about, MTHFR. So, this is the, this is the, the software called Functional Genomic Analysis. There’s a demo report we have. So, let’s talk a little bit about, MTHFR. So, we actually have a map called a methylation map. Now, what happens is, when you do your saliva test, you, you know, you spit, you put some saliva. in a collection kit, goes to a lab, takes out the DNA data, sends it to the computer, and now you can actually see it visually. Okay. So, it’s gonna take a second for this, data to load up, it’s, and each of these Circles, each of these ovals, is an enzyme. And the data gets loaded up to see where it is. So, until it gets loaded up here, I didn’t preload this. There it goes. So… The primary thing about methylation is There’s a nasty substance called homocysteine that, if it’s too high, can really be detrimental. The body takes methylfolate, and combines with methyl B12, To bring this back up to methionine. And then through the MAT genes, we make SAMI, S-adml methionine. Which is involved in so many processes. Then after it does its thing, it turns back into homocysteine. And this thing needs to keep spinning around. That’s why, you know, it’s a good idea to keep homocysteine at, do you have a number that you’d like? 7, 8? What do you like for a number? Dr. Deb Muth 00:55:24 Yeah, I like mine below 7. Bob Miller 00:55:26 Yeah. So if the homocysteine goes too high. It, caused all kinds of problems. So, here’s where you ask about the MTHFR. So, here you can see on this individual. I click on MTHFR, and you can see it comes up here, here’s the C677. And you can see here where it says, variants. I’ll… I’ll draw in case somebody’s having a hard time seeing that. So, you can see there’s nothing in there. That means there’s no genetic mutations. If one parent would have given a mutation, there’d be a 1. If both parents did, there’d be a 2. Now, here’s why Yes, methylation is important, I’m not saying it isn’t important, but look at this MTHFRC677. In my software. Only 42.5% of the population does not have a mutation. 44.7% have won. 12.9 have 2. So, this isn’t some rare, oh my god, I’m gonna die… Kind of thing, yeah. Dr. Deb Muth 00:56:27 Right. Bob Miller 00:56:28 So, And then what happens is that, and again, I’m not dismissing methylation, I… we could do a whole show on methylation. Bob Miller 00:56:36 get it. But I think that what people are doing is they’re, they’re learning about MTHFR, they get it measured, they panic. They start taking massive amounts of methylfolate, which many times is to their detriment. Dr. Deb Muth 00:56:50 Well, it’s… and isn’t it true, too, with MTHFR, like, you have to also look at MTR, MTRR, and the more we stack up of those, the more complicated than MTHFR can be. It’s not… it’s not as simple as just saying MTHFR 677 versus 1298. It’s more complex than that, kind of like what you’ve already shown with some of the other things. There’s more to it than just that one little sliver. Bob Miller 00:57:17 Oh, sure, well, let’s take a look. So, remember I said there’s a cofactor? One of the cofactors is called FAD. Just a Bob Miller observation, that’s all. But when people have trouble with their riboflavin and they don’t have enough FAD, They’re doing much worse than people who have just a C677. So, right here, you could have perfect C677th. And if you don’t have the cofactor, it’s not gonna work, okay? Dr. Deb Muth 00:57:48 And as you said, there’s an MTR enzyme. Bob Miller 00:57:51 that takes methylfolate and methyl B12, to spin it around. So, here on this individual. here’s your… here’s your B vitamins, or I’m sorry, your B12s. There’s an enzyme called TCN1 that takes it from the stomach into the blood. Then there’s other enzymes that take it from the blood into the tissue. And if you’re having trouble here. Well, then you’re not going to have this working, so… Even if you don’t have MTHFR, And you have MTR, like this, no, I’m sorry, this person doesn’t. But they have the MTRR, and then they don’t have enough B12, this isn’t gonna work, aside from that. And then there’s a middle pathway. And then there’s enzymes called the MAT1. they take the methionine to the salmon. If that’s not working, we stick… we get stuck in methionine. So, it’s, it’s not just an MTHFR. And then, one of the things that people forget about. is through these CBS enzymes and CTH, We make cysteine, which is needed to make glutathione. The master antioxidant. So, it really is that… I call it the, The 3D chess game played underwater. Dr. Deb Muth 00:59:07 It really is. I mean, I see people who have CVS, COMT, glutathione, MGHFR genes. And some of them function just fine. Like, they have Like, I look at this person and I’m like, oh my gosh, I don’t know how they’re functioning because they’re double mutated on so many pathways, but yet they don’t have a lot of symptoms, they don’t have a lot of complications. Somehow their body has figured out a way to adapt to what it has so it can stay alive and it can function at a high functioning level. Bob Miller 00:59:36 Yeah, and they may be, you know, eating right? Yeah. Staying out of a moldy house. reducing stress. So, it’s diet, it’s stress, it’s genetics, environmental factors. So, yeah, we can’t just say somebody’s gonna be good or somebody’s gonna be bad. You know, some people get scared, oh, I got all these, it’s like, well… Bob Miller 00:59:56 Are you living in a moldy house? You know, and if you live in a moldy house and your glucuronidation pathway doesn’t do well, or if you’re, you know, a smoker, or you’re constantly eating junk food, I mean, all. Bob Miller 01:00:07 things come together. Although, you know, when we focus on genetics, we’re well aware that this is just a piece of it. You know, you could have identical twins, Genetically, and if one… Is exposed to mold and smokes and drinks and stressed out. They’re gonna be a whole lot sicker than their sibling. Bob Miller 01:00:28 Yep. Dr. Deb Muth 01:00:29 Yeah, it’s that concept of taking twins, and one gets raced with one family, and one gets raced with another family, and they don’t have the same… problems that… that each other have, you know? It’s a very unique situation, we don’t think about that enough. Bob Miller 01:00:44 Alright, so again, genetics loads the gun, environment pulls the trigger. So, if you’ve got a loaded gun, but you don’t have the triggers, you’re okay. Dr. Deb Muth 01:00:53 Yeah. Bob Miller 01:00:54 Yeah. So, remember I said I was going to talk about NAD? So, here’s NAD, and what it does, it turns into NADH. And what NADH does, it, Comes down this pathway, what’s called the electron transport chain. And that makes your ATP, that’s your energy. So, if this wasn’t working, we wouldn’t be alive, because we wouldn’t have energy. So it donates an electron, that’s why it’s called electron transport chain. So, we need NAD, To make this, to make the energy. But remember I said that NQ01, this would probably be, like, on my top 10 list of… Bob Miller 01:01:36 Much more important than MTHFR. This one takes NADH back to NAD. If we’re stuck over here, We’re low in this NAD+, But what happens is, NQO1 also provides CoQ10. And CoQ10 Is what’s needed for the electron transport chain to flow. So if we get too many electrons up here. And they don’t turn them into energy. They make a nasty free radical called superoxide. Okay. Now, NAD plus also makes NADPH, And that is needed. Remember I said we need to recycle our antioxidants. So, if we have a problem with FAD from riboflavin. Yeah, we don’t have enough NADPH, Glutathione’s not getting recycled, and you’re gonna be inflamed. And you take glutathione, you’ll feel worse. There’s another enzyme called thimoredoxin. Same thing, needs NADPH and FAD. And same way with your nitric oxide, there’s an enzyme called NOS3, That makes the nitric oxide that dilates your blood vessels. And if we don’t have enough NADPH or fat, You’re gonna make superoxide. Rather than nitric oxide. Now, remember

In this solo episode, I'm getting into one of the most common (and most misunderstood) multiple sclerosis symptoms… MS spasticity. If your legs feel heavy, your muscles lock up, or you've been told it's "just tightness"… this one is for you. I'll walk you through what spasticity actually is, what's happening in your body when it shows up, and why it can have such a big impact on your daily life and mobility. We'll cover: → The Modified Ashworth Scale (and what those numbers really mean) → The difference between spasms, cramps, and true spasticity → Common triggers like fatigue, infection, heat, and stress → What actually helps… including physical therapy-based strategies, stretching, medications, and the latest research on cannabis and electrical stimulation Press play and let's get into it. Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → The Progress Method for MS: https://www.doctorgretchenhawley.com/TheProgressMethodForMS → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

How can movement support you to live well with MS, especially when symptoms like fatigue, pain or balance changes get in the way? Physiotherapist Jody Barber joins Vickie Hadge and Gina Beach to answer community questions on movement, exercise and living well with multiple sclerosis. Drawing on more than 30 years' experience supporting people with neurological conditions, Jody explores how physiotherapy can help with fatigue, pain, balance, spasticity, mobility and confidence. The conversation covers practical ways to adapt movement as symptoms change, why all movement can count, how exercise may support cognition, and when to seek specialist advice. Jody also discusses complementary approaches such as massage, acupuncture, water-based exercise, yoga and relaxation, while emphasising the importance of finding movement that feels enjoyable, manageable and meaningful. This episode is a webinar highlights special – originally recorded as a live Overcoming MS webinar and now edited for the podcast to bring you the key insights, questions and takeaways in one place. Watch this episode on YouTube. Keep reading for the topics, timestamps, and our guest's bio. Watch the original webinar here: https://overcomingms.org/live-well/resources/past-webinars/ask-the-expert-live-with-jody-barber 02:06 Jody's experience supporting people with MS 05:00 Understanding muscle fatigue and adapting exercise 08:55 Complementary therapies for stiffness, soreness and pain 11:31 Rebuilding core strength with functional movement 14:36 Finding MS-friendly yoga and movement classes 16:14 Adapting exercise as mobility needs change 19:07 Managing pain, anxiety and fear of movement 23:59 Sleep difficulties, symptoms and practical routines 29:04 Explaining invisible MS symptoms to others 31:39 Choosing the right physiotherapist for MS care 33:26 Why exercise matters for brain health 34:47 Nerve pain, breathing and gentle movement 37:02 Spasticity, weight bearing and relaxation strategies 39:09 Vestibular symptoms, dizziness and balance support 42:21 Exercise, cognition and brain fog in MS 43:52 Foot drop, mirror therapy and foot mobility 46:20 Simple home exercises using body weight 47:07 Electrical muscle stimulation and foot drop support New to Overcoming MS? Learn why lifestyle matters in MS - begin your journey at our 'Get started' page Connect with others following Overcoming MS on the Live Well Hub Visit the Overcoming MS website Follow us on social media: Facebook Instagram YouTube Pinterest Don't miss out: Subscribe to this podcast and never miss an episode. Listen to our archive of Living Well with MS here. Make sure you sign up to our newsletter to hear our latest tips and news about living a full and happy life with MS. Support us: If you enjoy this podcast and want to help us continue creating future podcasts, please leave a donation here. Feel free to share your comments and suggestions for future guests and episode topics by emailing podcast@overcomingms.org. If you like Living Well with MS, please leave a 5-star review.

Dr. Caroline Leclercq has dedicated over 35 years to understanding upper limb spasticity. Her recent paper reveals how hyperselective neurectomy can transform lives by addressing spastic components and improving patient outcomes. But it's not just about the surgery—early intervention is key! By collaborating with rehabilitation centers, they ensure that patients receive the best care tailored to their needs. What's the takeaway? Effective treatment requires a comprehensive understanding of each patient's unique challenges.

In this episode host, Erin Gallardo, PT, DPT, NCS speaks with Chris McElderry, PT, DPT, NCS about how dry needling can be used in neuro rehab, particularly for people post-stroke. Chris explains why he pursued dry needling, how using it in PT differs from acupuncture, and walks through what a typical session looks like, including safety, side effects, and billing considerations. He shares clinical examples of using dry needling to address spasticity, hypertonicity, pain, and range of motion limitations, and discusses current research on short-term effects for spasticity and pain reduction. Erin and Chris also clarify the differences between spasticity and hypertonicity, touch on contracture management, and highlight where dry needling can be a useful adjunct—not a standalone cure—in helping neuro clients move and feel better. Follow Chris McElderry, PT, DPT, NCS @theneuroguy_dpt  Ebrahimzadeh M, Nakhostin Ansari N, Abdollahi I, Akhbari B, Dommerholt J. Changes in Corticospinal Tract Consistency after Dry Needling in a Stroke Patient. Case Rep Neurol Med. 2024 Sep 14;2024:5115313. doi: 10.1155/2024/5115313. PMID: 39309410; PMCID: PMC11416164. Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H. A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation. 2017;40(3):325-336. doi: 10.3233/NRE-161420. PMID: 28222554. Fernández-de-Las-Peñas C, Pérez-Bellmunt A, Llurda-Almuzara L, Plaza-Manzano G, De-la-Llave-Rincón AI, Navarro-Santana MJ. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain Med. 2021 Feb 4;22(1):131-141. doi: 10.1093/pm/pnaa392. PMID: 33338222. Núñez-Cortés R, Cruz-Montecinos C, Vásquez-Rosales P, et al. Effectiveness of dry needling in the treatment of spasticity in stroke patients: A systematic review. J Body Mov Ther. 2020;24(3):113-122. Suputtitada A, et al. Emerging theory of sensitization in post-stroke muscle spasticity: Implications for dry needling and other interventions. Front Rehabil Sci. 2023;4:1169087. Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complement Ther Med. 2020 Aug;52:102515. doi: 10.1016/j.ctim.2020.102515. Epub 2020 Jul 16. PMID: 32951759.

En este episodio abordo la farmacología en neurorrehabilitación del adulto desde una perspectiva clínica y realista, pensada especialmente para profesionales no médicos que conviven a diario con informes, pautas y nombres de fármacos sin disponer siempre de un marco claro para interpretarlos. Recorremos los principales medicamentos utilizados en patologías neurológicas frecuentes —ictus, lesión medular, esclerosis múltiple, enfermedad de Parkinson, ELA, distonías y traumatismo craneoencefálico— diferenciando entre tratamientos agudos, terapias modificadoras de la enfermedad y manejo farmacológico de secuelas. A lo largo del episodio explico de forma progresiva los mecanismos de acción, la base neurofisiológica y el estado actual de la evidencia, poniendo especial énfasis en qué fármacos realmente cambian el pronóstico y cuáles cumplen un papel fundamentalmente sintomático. El objetivo no es prescribir, sino entender mejor cómo la farmacología condiciona la recuperación, la participación en terapia y la toma de decisiones en neurorrehabilitación, con una mirada crítica y basada en la evidencia disponible. Referencias del episodio: 1.     Adams, M. M., & Hicks, A. L. (2005). Spasticity after spinal cord injury. Spinal cord, 43(10), 577–586. https://doi.org/10.1038/sj.sc.3101757 (https://pubmed.ncbi.nlm.nih.gov/15838527/). 2.     AFFINITY Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 19(8), 651–660. https://doi.org/10.1016/S1474-4422(20)30207-6 (https://pubmed.ncbi.nlm.nih.gov/32702334/). 3.     Angeli, C. A., Edgerton, V. R., Gerasimenko, Y. P., & Harkema, S. J. (2014). Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans. Brain : a journal of neurology, 137(Pt 5), 1394–1409. https://doi.org/10.1093/brain/awu038 (https://pubmed.ncbi.nlm.nih.gov/24713270/). 4.     Bracken, M. B., Shepard, M. J., Collins, W. F., Holford, T. R., Young, W., Baskin, D. S., Eisenberg, H. M., Flamm, E., Leo-Summers, L., & Maroon, J. (1990). A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. The New England journal of medicine, 322(20), 1405–1411. https://doi.org/10.1056/NEJM199005173222001 (https://pubmed.ncbi.nlm.nih.gov/2278545/). 5.     Bracken, M. B., Shepard, M. J., Holford, T. R., Leo-Summers, L., Aldrich, E. F., Fazl, M., Fehlings, M., Herr, D. L., Hitchon, P. W., Marshall, L. F., Nockels, R. P., Pascale, V., Perot, P. L., Jr, Piepmeier, J., Sonntag, V. K., Wagner, F., Wilberger, J. E., Winn, H. R., & Young, W. (1997). Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA, 277(20), 1597–1604 (https://pubmed.ncbi.nlm.nih.gov/9168289/). 6.     Cardenas, D. D., Ditunno, J. F., Graziani, V., McLain, A. B., Lammertse, D. P., Potter, P. J., Alexander, M. S., Cohen, R., & Blight, A. R. (2014). Two phase 3, multicenter, randomized, placebo-controlled clinical trials of fampridine-SR for treatment of spasticity in chronic spinal cord injury. Spinal cord, 52(1), 70–76. https://doi.org/10.1038/sc.2013.137 (https://pubmed.ncbi.nlm.nih.gov/24216616/). 7.     Chollet, F., Tardy, J., Albucher, J. F., Thalamas, C., Berard, E., Lamy, C., Bejot, Y., Deltour, S., Jaillard, A., Niclot, P., Guillon, B., Moulin, T., Marque, P., Pariente, J., Arnaud, C., & Loubinoux, I. (2011). Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet. Neurology, 10(2), 123–130. https://doi.org/10.1016/S1474-4422(10)70314-8 (https://pubmed.ncbi.nlm.nih.gov/21216670/). 8.     Dávalos, A., Alvarez-Sabín, J., Castillo, J., Díez-Tejedor, E., Ferro, J., Martínez-Vila, E., Serena, J., Segura, T., Cruz, V. T., Masjuan, J., Cobo, E., Secades, J. J., & International Citicoline Trial on acUte Stroke (ICTUS) trial investigators (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet (London, England), 380(9839), 349–357. https://doi.org/10.1016/S0140-6736(12)60813-7 (https://pubmed.ncbi.nlm.nih.gov/22691567/). 9.     EFFECTS Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 19(8), 661–669. https://doi.org/10.1016/S1474-4422(20)30219-2 (https://pubmed.ncbi.nlm.nih.gov/32702335/). 10.  Fehlings, M. G., Theodore, N., Harrop, J., Maurais, G., Kuntz, C., Shaffrey, C. I., Kwon, B. K., Chapman, J., Yee, A., Tighe, A., & McKerracher, L. (2011). A phase I/IIa clinical trial of a recombinant Rho protein antagonist in acute spinal cord injury. Journal of neurotrauma, 28(5), 787–796. https://doi.org/10.1089/neu.2011.1765 (https://pubmed.ncbi.nlm.nih.gov/21381984/). 11.  FOCUS Trial Collaboration (2019). Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet (London, England), 393(10168), 265–274. https://doi.org/10.1016/S0140-6736(18)32823-X (https://pubmed.ncbi.nlm.nih.gov/30528472/). 12.  Forgione, N., & Fehlings, M. G. (2014). Rho-ROCK inhibition in the treatment of spinal cord injury. World neurosurgery, 82(3-4), e535–e539. https://doi.org/10.1016/j.wneu.2013.01.009 (http://pubmed.ncbi.nlm.nih.gov/23298675/). 13.  Fournier, A. E., Takizawa, B. T., & Strittmatter, S. M. (2003). Rho kinase inhibition enhances axonal regeneration in the injured CNS. The Journal of neuroscience : the official journal of the Society for Neuroscience, 23(4), 1416–1423. https://doi.org/10.1523/JNEUROSCI.23-04-01416.2003 (https://pubmed.ncbi.nlm.nih.gov/12598630/). 14.  Giacino, J. T., Whyte, J., Bagiella, E., Kalmar, K., Childs, N., Khademi, A., Eifert, B., Long, D., Katz, D. I., Cho, S., Yablon, S. A., Luther, M., Hammond, F. M., Nordenbo, A., Novak, P., Mercer, W., Maurer-Karattup, P., & Sherer, M. (2012). Placebo-controlled trial of amantadine for severe traumatic brain injury. The New England journal of medicine, 366(9), 819–826. https://doi.org/10.1056/NEJMoa1102609 (https://pubmed.ncbi.nlm.nih.gov/22375973/). 15.  Goodman, A. D., Brown, T. R., Krupp, L. B., Schapiro, R. T., Schwid, S. R., Cohen, R., Marinucci, L. N., Blight, A. R., & Fampridine MS-F203 Investigators (2009). Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet (London, England), 373(9665), 732–738. https://doi.org/10.1016/S0140-6736(09)60442-6 (https://pubmed.ncbi.nlm.nih.gov/19249634/). 16.  Goodman, A. D., Brown, T. R., Edwards, K. R., Krupp, L. B., Schapiro, R. T., Cohen, R., Marinucci, L. N., Blight, A. R., & MSF204 Investigators (2010). A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Annals of neurology, 68(4), 494–502. https://doi.org/10.1002/ana.22240 (https://pubmed.ncbi.nlm.nih.gov/20976768/). 17.  Hurlbert, R. J., Hadley, M. N., Walters, B. C., Aarabi, B., Dhall, S. S., Gelb, D. E., Rozzelle, C. J., Ryken, T. C., & Theodore, N. (2013). Pharmacological therapy for acute spinal cord injury. Neurosurgery, 72 Suppl 2, 93–105. https://doi.org/10.1227/NEU.0b013e31827765c6 (https://pubmed.ncbi.nlm.nih.gov/23417182/). 18.  Johnston, S. C., Amarenco, P., Denison, H., Evans, S. R., Himmelmann, A., James, S., Knutsson, M., Ladenvall, P., Molina, C. A., Wang, Y., & THALES Investigators (2020). Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. The New England journal of medicine, 383(3), 207–217. https://doi.org/10.1056/NEJMoa1916870 (https://pubmed.ncbi.nlm.nih.gov/32668111/). 19.  Kheder, A., & Nair, K. P. (2012). Spasticity: pathophysiology, evaluation and management. Practical neurology, 12(5), 289–298. https://doi.org/10.1136/practneurol-2011-000155 (https://pubmed.ncbi.nlm.nih.gov/22976059/). 20.  Kirkman, M. A., Day, J., Gehring, K., Zienius, K., Grosshans, D., Taphoorn, M., Li, J., & Brown, P. D. (2022). Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. The Cochrane database of systematic reviews, 11(11), CD011335. https://doi.org/10.1002/14651858.CD011335.pub3 (https://pubmed.ncbi.nlm.nih.gov/36427235/). 21.  Martinsson L, Hårdemark H, Eksborg S. Amphetamines for improving recovery after stroke. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD002090. doi: 10.1002/14651858.CD002090.pub2. PMID: 17253474; PMCID: PMC12278358 (https://pubmed.ncbi.nlm.nih.gov/17253474/). 22.  Miller, T. M., Cudkowicz, M. E., Genge, A., Shaw, P. J., Sobue, G., Bucelli, R. C., Chiò, A., Van Damme, P., Ludolph, A. C., Glass, J. D., Andrews, J. A., Babu, S., Benatar, M., McDermott, C. J., Cochrane, T., Chary, S., Chew, S., Zhu, H., Wu, F., Nestorov, I., … VALOR and OLE Working Group (2022). Trial of Antisense Oligonucleotide Tofersen for SOD1 ALS. The New England journal of medicine, 387(12), 1099–1110. https://doi.org/10.1056/NEJMoa2204705 (https://pubmed.ncbi.nlm.nih.gov/36129998/). 23.  Mueller, B. K., Mack, H., & Teusch, N. (2005). Rho kinase, a promising drug target for neurological disorders. Nature reviews. Drug discovery, 4(5), 387–398. https://doi.org/10.1038/nrd1719 (https://pubmed.ncbi.nlm.nih.gov/15864268/). 24.  Nourbakhsh, B., Revirajan, N., & Waubant, E. (2018). Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial. Contemporary clinical trials, 64, 67–76. https://doi.org/10.1016/j.cct.2017.11.005 (https://pubmed.ncbi.nlm.nih.gov/29113955/). 25.  Paganoni, S., Hendrix, S., Dickson, S. P., Knowlton, N., Macklin, E. A., Berry, J. D., Elliott, M. A., Maiser, S., Karam, C., Caress, J. B., Owegi, M. A., Quick, A., Wymer, J., Goutman, S. A., Heitzman, D., Heiman-Patterson, T. D., Jackson, C. E., Quinn, C., Rothstein, J. D., Kasarskis, E. J., … Cudkowicz, M. E. (2021). Long-term survival of participants in the CENTAUR trial of sodium phenylbutyrate-taurursodiol in amyotrophic lateral sclerosis. Muscle & nerve, 63(1), 31–39. https://doi.org/10.1002/mus.27091 (https://pubmed.ncbi.nlm.nih.gov/33063909/). 26.  Schwab M. E. (2004). Nogo and axon regeneration. Current opinion in neurobiology, 14(1), 118–124. https://doi.org/10.1016/j.conb.2004.01.004 (https://pubmed.ncbi.nlm.nih.gov/15018947/). 27.  Shneider, N. A., Harms, M. B., Korobeynikov, V. A., Rifai, O. M., Hoover, B. N., Harrington, E. A., Aziz-Zaman, S., Singleton, J., Jamil, A., Madan, V. R., Lee, I., Andrews, J. A., Smiley, R. M., Alam, M. M., Black, L. E., Shin, M., Watts, J. K., Walk, D., Newman, D., Pascuzzi, R. M., … Bennett, C. F. (2025). Antisense oligonucleotide jacifusen for FUS-ALS: an investigator-initiated, multicentre, open-label case series. Lancet (London, England), 405(10494), 2075–2086. https://doi.org/10.1016/S0140-6736(25)00513-6 (https://pubmed.ncbi.nlm.nih.gov/40414239/). 28.  Stocchi, F., Bravi, D., Emmi, A., & Antonini, A. (2024). Parkinson disease therapy: current strategies and future research priorities. Nature reviews. Neurology, 20(12), 695–707. https://doi.org/10.1038/s41582-024-01034-x (https://pubmed.ncbi.nlm.nih.gov/39496848/).

In this episode, I'm joined by Dr. Steve Capobianco, chiropractor and co-founder of RockTape, to dive into the benefits of kinesiology tape for people living with multiple sclerosis (MS). We discuss how kinesiology tape can help with challenging MS symptoms like spasticity, muscle weakness, balance issues, and even foot drop. You'll learn practical strategies for improving mobility and movement using tape, gain insights on how this tool works by communicating with the nervous system, and get tips on safely applying it at home. If you're searching for MS exercises, expert advice, and evidence-based ways to get stronger and walk better with MS, this friendly conversation is filled with actionable tools for boosting your independence and confidence. Whether you have relapsing or progressive MS, tune in for empowerment and inspiration! About Dr. Steve Capobianco: Dr. Steven Capobianco, a chiropractor with over 20 years of experience and co-founder of RockTape. Dr. Capobianco is a passionate educator and innovator in manual and movement therapy, with advanced training including a post-doctoral diploma in rehabilitation and certification as a strength and conditioning specialist. He's dedicated his career to helping people understand how simple tools like kinesiology tape can communicate with the nervous system to improve movement and reduce symptoms. Resources Mentioned in this episode: How Kinesiology Tape Can Help People with Multiple Sclerosis Feel and Move Better: https://rocktape.com/blogs/rocktape/how-kinesiology-tape-can-help-people-with-multiple-sclerosis-feel-and-move-better Connect with Dr. Steve Capobianco:Website: https://rocktape.com/YouTube: https://www.youtube.com/@RockTapeGoStrongerLongerMovement Advocate Instagram: https://www.instagram.com/themovementadvocate/ Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

In this Q&A episode, host Paul Wirkus, MD, FAAP and Shawn Mendenhall, MD address common clinical questions related to managing upper extremity spasticity in children. The conversation explores how to balance orthopedic readiness and bone maturity with developmental readiness and family goals - highlighting the importance of individualized timing and shared decision-making. They also discuss the collaborative relationship between general pediatricians and subspecialists, particularly when families live far from surgical centers and rely on their primary care provider to coordinate ongoing care. Listeners will gain practical insights into communication, expectation-setting, and supporting families throughout the treatment journey. Have a question? Email questions@vcurb.com.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In the third episode of our upper extremity spasticity series, host Paul Wirkus, MD, FAAP and Shawn Mendenhall, MD focus on what success truly looks like - both in the short term and long term. Our guests discuss how to measure meaningful outcomes for children, from functional gains to improved comfort and participation in daily activities. We also look ahead to the future of spasticity care, exploring emerging approaches, evolving surgical techniques, and innovations that may improve assessment and treatment. Together, the conversation highlights the importance of individualized goals, interdisciplinary follow-through, and continuous reevaluation to ensure each child progresses toward their highest potential. Have a question? Email questions@vcurb.com. They will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode, host Paul Wirkus, MD, FAAP and Shawn Mendenhall, MD continue our discussion on upper extremity spasticity—focusing on individualized surgical planning. Our guests explore the range of surgical options available, emphasizing how treatment decisions should be tailored to each child's functional goals, pattern of spasticity, and overall care plan. The conversation highlights the importance of interdisciplinary collaboration and setting realistic expectations to achieve meaningful improvements in movement and quality of life. Have a question? Email questions@vcurb.com. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This week's episode with host Paul Wirkus, MD, FAAP and Shawn Mendenhall, MD focuses on recognizing and correctly identifying upper extremity spasticity in pediatric patients. Our discussion covers key clinical features, surgical updates, common causes, and practical assessment techniques to distinguish spasticity. Understanding these nuances is essential for accurate diagnosis and timely intervention to improve function and quality of life. Have a question? Email questions@vcurb.com. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

John shares his Vivistim experience and how spasticity shaped rehab—an honest look at small wins, setbacks, and hope in stroke recovery. The post Vivistim: One Stroke Survivor's Experience – And Why Spasticity Matters appeared first on Recovery After Stroke.

En este episodio nos adentramos en una técnica emergente que está ganando terreno en el tratamiento de la espasticidad: la crioneurolisis. Hablamos con el Dr. José Alexandre Pereira, uno de los referentes europeos en la aplicación clínica de esta intervención mínimamente invasiva, que utiliza frío extremo para bloquear de forma selectiva nervios periféricos y reducir el tono muscular patológico. Exploramos el origen histórico de la técnica, su reaparición en el ámbito rehabilitador, sus fundamentos neurofisiológicos, las indicaciones clínicas más comunes, y cómo se compara con otras estrategias como la toxina botulínica. También hablamos sobre los estudios en curso para seguir aumentando la evidencia científica. Un episodio técnico, pero profundamente clínico, donde la fisiología, la ecografía y la toma de decisiones terapéuticas se encuentran con la innovación. Podéis seguir al Dr. Pereira en LinkedIn: https://www.linkedin.com/in/dr-jose-pereira-physical-medicine-and-rehabilitation/ Referencias del episodio: 1) Li, S., Winston, P., & Mas, M. F. (2024). Spasticity Treatment Beyond Botulinum Toxins. Physical medicine and rehabilitation clinics of North America, 35(2), 399–418. https://doi.org/10.1016/j.pmr.2023.06.009 (https://pubmed.ncbi.nlm.nih.gov/38514226/). 2) Rubenstein, J., Harvey, A. W., Vincent, D., & Winston, P. (2021). Cryoneurotomy to Reduce Spasticity and Improve Range of Motion in Spastic Flexed Elbow: A Visual Vignette. American journal of physical medicine & rehabilitation, 100(5), e65. https://doi.org/10.1097/PHM.0000000000001624 (https://pubmed.ncbi.nlm.nih.gov/33105153/). 3) Winston, P., & Vincent, D. (2024). Cryoneurolysis as a Novel Treatment for Spasticity, Associated Pain and Presumed Contracture. Advances in rehabilitation science and practice, 13, 27536351241285198. https://doi.org/10.1177/27536351241285198 (https://pubmed.ncbi.nlm.nih.gov/39377080/). 4) Winston, P., MacRae, F., Rajapakshe, S., Morrissey, I., Boissonnault, È., Vincent, D., & Hashemi, M. (2023). Analysis of Adverse Effects of Cryoneurolysis for the Treatment of Spasticity. American journal of physical medicine & rehabilitation, 102(11), 1008–1013. https://doi.org/10.1097/PHM.0000000000002267 (https://pubmed.ncbi.nlm.nih.gov/37104641/).

This week, Dr Javvad Haider joins us once again to talk about the management of spasticity. This episode covers a good chink of neurophysiology and pathophysiology to help understand how spasticity is triggered, so we can arrange the best treatments

Pillow Power: Portable, Personal, Planet-Friendly Heat.  Brushing Breakthroughs: The AI Approach to Oral Automation.  Socks, Slippers and Smarts: Saros Sweeps into the Spotlight.  Trucking Towards Tomorrow: Volvo's Vision for a Cleaner, Cleverer Commute.  Peering Past Plaster: FBI's Futuristic ‘Find-Through-Walls' Tech.  Suiting Science: Stimulating Solutions for Spasticity.  Sensors, Speed and Smarts: Ducati's Data-Driven Dominance.  Super Speeders Slowed: Smart Safety Systems Set to Save Streets.  Honda Hits the Hybrid Highway: A Strategic Shift After Scrapped Super Merger. 

Conversem amb el director Oliver Laxe i l'actor Sergi López després de guanyar el Premi del Jurat del Festival de Canes amb ‘Sirât'. Entrevistem l'actor Marc Buxaderas que presenta el monòleg ‘Spasticity' a La Villarroel. I Ferran Bassaganyes ens comparteix la seva mixtape

Parlem amb l'actor Marc Buxaderas, protagonista d'obres com 'Fantàstic Ramon' o 'Mare de sucre' de la Clàudia Cedó, sobre el monòleg 'Spasticity' que torna a la Villarroel. 

Conversem amb el director Oliver Laxe i l'actor Sergi López després de guanyar el Premi del Jurat del Festival de Canes amb ‘Sirât'. Entrevistem l'actor Marc Buxaderas que presenta el monòleg ‘Spasticity' a La Villarroel. I Ferran Bassaganyes ens comparteix la seva mixtape

Parlem amb l'actor Marc Buxaderas, protagonista d'obres com 'Fantàstic Ramon' o 'Mare de sucre' de la Clàudia Cedó, sobre el monòleg 'Spasticity' que torna a la Villarroel. 

En este episodio, nos sumergimos en la vía motora más determinante del sistema nervioso humano: el tracto corticoespinal. A través de un recorrido detallado por su evolución, desarrollo, anatomía y función, analizamos por qué esta vía representa la gran apuesta evolutiva por la motricidad fina y por qué su lesión tiene consecuencias tan devastadoras. Hablamos de neurofisiología, de plasticidad, de evaluación con TMS y DTI, de terapias intensivas, neuromodulación, farmacología, robótica y de las posibilidades —y límites— reales de su regeneración tras un ictus. Si te interesa entender en profundidad cómo se ejecuta el movimiento voluntario y qué ocurre cuando esa vía falla, este episodio es para ti. Referencias del episodio: 1. Alawieh, A., Tomlinson, S., Adkins, D., Kautz, S., & Feng, W. (2017). Preclinical and Clinical Evidence on Ipsilateral Corticospinal Projections: Implication for Motor Recovery. Translational stroke research, 8(6), 529–540. https://doi.org/10.1007/s12975-017-0551-5 (https://pubmed.ncbi.nlm.nih.gov/28691140/). 2. Cho, M. J., Yeo, S. S., Lee, S. J., & Jang, S. H. (2023). Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine, 102(17), e33604. https://doi.org/10.1097/MD.0000000000033604 (https://pubmed.ncbi.nlm.nih.gov/37115067/). 3. Dalamagkas, K., Tsintou, M., Rathi, Y., O'Donnell, L. J., Pasternak, O., Gong, X., Zhu, A., Savadjiev, P., Papadimitriou, G. M., Kubicki, M., Yeterian, E. H., & Makris, N. (2020). Individual variations of the human corticospinal tract and its hand-related motor fibers using diffusion MRI tractography. Brain imaging and behavior, 14(3), 696–714. https://doi.org/10.1007/s11682-018-0006-y (https://pubmed.ncbi.nlm.nih.gov/30617788/). 4. Duque-Parra, Jorge Eduardo, Mendoza-Zuluaga, Julián, & Barco-Ríos, John. (2020). El Tracto Cortico Espinal: Perspectiva Histórica. International Journal of Morphology, 38(6), 1614-1617. https://dx.doi.org/10.4067/S0717-95022020000601614 (https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022020000601614). 5. Eyre, J. A., Miller, S., Clowry, G. J., Conway, E. A., & Watts, C. (2000). Functional corticospinal projections are established prenatally in the human foetus permitting involvement in the development of spinal motor centres. Brain : a journal of neurology, 123 ( Pt 1), 51–64. https://doi.org/10.1093/brain/123.1.51 (https://pubmed.ncbi.nlm.nih.gov/10611120/). 6. He, J., Zhang, F., Pan, Y., Feng, Y., Rushmore, J., Torio, E., Rathi, Y., Makris, N., Kikinis, R., Golby, A. J., & O'Donnell, L. J. (2023). Reconstructing the somatotopic organization of the corticospinal tract remains a challenge for modern tractography methods. Human brain mapping, 44(17), 6055–6073. https://doi.org/10.1002/hbm.26497 (https://pubmed.ncbi.nlm.nih.gov/37792280/). 7. Huang, L., Yi, L., Huang, H., Zhan, S., Chen, R., & Yue, Z. (2024). Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta neurologica Belgica, 124(1), 25–36. https://doi.org/10.1007/s13760-023-02377-w (https://pubmed.ncbi.nlm.nih.gov/37704780/). 8. Kazim, S. F., Bowers, C. A., Cole, C. D., Varela, S., Karimov, Z., Martinez, E., Ogulnick, J. V., & Schmidt, M. H. (2021). Corticospinal Motor Circuit Plasticity After Spinal Cord Injury: Harnessing Neuroplasticity to Improve Functional Outcomes. Molecular neurobiology, 58(11), 5494–5516. https://doi.org/10.1007/s12035-021-02484-w (https://pubmed.ncbi.nlm.nih.gov/34341881/). 9. Kwon, Y. M., Kwon, H. G., Rose, J., & Son, S. M. (2016). The Change of Intra-cerebral CST Location during Childhood and Adolescence; Diffusion Tensor Tractography Study. Frontiers in human neuroscience, 10, 638. https://doi.org/10.3389/fnhum.2016.00638 (https://pubmed.ncbi.nlm.nih.gov/28066209/). 10. Lemon, R. N., Landau, W., Tutssel, D., & Lawrence, D. G. (2012). Lawrence and Kuypers (1968a, b) revisited: copies of the original filmed material from their classic papers in Brain. Brain : a journal of neurology, 135(Pt 7), 2290–2295. https://doi.org/10.1093/brain/aws037 (https://pubmed.ncbi.nlm.nih.gov/22374938/). 11. Li S. (2017). Spasticity, Motor Recovery, and Neural Plasticity after Stroke. Frontiers in neurology, 8, 120. https://doi.org/10.3389/fneur.2017.00120 (https://pubmed.ncbi.nlm.nih.gov/28421032/). 12. Liu, Z., Chopp, M., Ding, X., Cui, Y., & Li, Y. (2013). Axonal remodeling of the corticospinal tract in the spinal cord contributes to voluntary motor recovery after stroke in adult mice. Stroke, 44(7), 1951–1956. https://doi.org/10.1161/STROKEAHA.113.001162 (https://pubmed.ncbi.nlm.nih.gov/23696550/). 13. Liu, K., Lu, Y., Lee, J. K., Samara, R., Willenberg, R., Sears-Kraxberger, I., Tedeschi, A., Park, K. K., Jin, D., Cai, B., Xu, B., Connolly, L., Steward, O., Zheng, B., & He, Z. (2010). PTEN deletion enhances the regenerative ability of adult corticospinal neurons. Nature neuroscience, 13(9), 1075–1081. https://doi.org/10.1038/nn.2603 (https://pubmed.ncbi.nlm.nih.gov/20694004/). 14. Schieber M. H. (2007). Chapter 2 Comparative anatomy and physiology of the corticospinal system. Handbook of clinical neurology, 82, 15–37. https://doi.org/10.1016/S0072-9752(07)80005-4 (https://pubmed.ncbi.nlm.nih.gov/18808887/). 15. Stinear, C. M., Barber, P. A., Smale, P. R., Coxon, J. P., Fleming, M. K., & Byblow, W. D. (2007). Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain : a journal of neurology, 130(Pt 1), 170–180. https://doi.org/10.1093/brain/awl333 (https://pubmed.ncbi.nlm.nih.gov/17148468/). 16. Usuda, N., Sugawara, S. K., Fukuyama, H., Nakazawa, K., Amemiya, K., & Nishimura, Y. (2022). Quantitative comparison of corticospinal tracts arising from different cortical areas in humans. Neuroscience research, 183, 30–49. https://doi.org/10.1016/j.neures.2022.06.008 (https://pubmed.ncbi.nlm.nih.gov/35787428/). 17. Ward, N. S., Brander, F., & Kelly, K. (2019). Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. Journal of neurology, neurosurgery, and psychiatry, 90(5), 498–506. https://doi.org/10.1136/jnnp-2018-319954 (https://pubmed.ncbi.nlm.nih.gov/30770457/). 18. Welniarz, Q., Dusart, I., & Roze, E. (2017). The corticospinal tract: Evolution, development, and human disorders. Developmental neurobiology, 77(7), 810–829. https://doi.org/10.1002/dneu.22455 (https://pubmed.ncbi.nlm.nih.gov/27706924/).

Send us a message about the podcast. For questions about MS please contact our helpline 0800 032 38 39Spasticity and spasms are common MS symptoms that vary from person to person and can be challenging to understand and manage.  In this episode, we explore how these symptoms can feel with the help of our MS community and what you can do about them.  We asked MS specialist physiotherapist Wendy Hendrie to share her near 40 years of experience with us.  We are very glad we did, because we learned such a huge amount. In fact, so much so that we can almost guarantee you will too in the next hour.  And this know-how could make a real difference to the way you understand and approach your spasticity and spasms.  She breaks these complex symptoms down in a way that's easy to follow. She explores trigger factors, including pain – even pain you can't feel due to loss of sensation – bladder and bowels, posture and positioning including pelvis alignment and head movement. Plus exercise, night spasms and the importance of getting medication reviews especially if you haven't seen your MS team in a while.Episode notesSpasticity and spasms - MS Trust informationWhat do MS spasticity and muscle spasms feel like? - MS Trust informationManaging spasticity and spasms - MS Trust informationDownload or order our free book on Managing spasticity and spasms - MS Trust informationLearn what may be triggering your spasticity and spasmsThrower B et al.Recognition, Description, and Variability of Spasticity in Individuals With Multiple Sclerosis and Potential Barriers to Clinician-Patient Dialogue: Results From SEEN-MSS, a Large-Scale, Self-Reported SurveyInternational Journal of MS Care. 2024; 26 (2): 75-80SummaryPeer support: join our MS Trust Facebook community (public group)Peer support: join our Advanced MS Care and Support Facebook community (private group) Spoon theory explanation video

This is a non-promotional podcast funded and developed by AbbVie for healthcare professionals only. The content of this podcast is correct at the time of recording, which is December 2024. The views expressed in this podcast are those of the individual speakers and do not necessarily reflect the view of AbbVie or EMJ If you are listening to this podcast through a podcast app, please note that any advertisements you may hear are not affiliated with this podcast or AbbVie in any way. To stop receiving podcast notifications, please unsubscribe from this series in your podcast player. The Post-Stroke Spasticity Classification System was created and funded by AbbVie with the assistance of a group of international experts in the field of Post-Stroke Spasticity, utilising both published risk factors and their own clinical experience. BONT-AA-00049-MC April 2025

"Cannabis in the Management of Multiple Sclerosis-Related Pain and Spasticity" From ASRA Pain Medicine News, November 2024. See the original article at www.asra.com/november24news for figures and references. This material is copyrighted. Support the show

In this episode, our host Meghan Mardashti, OMS 4, interviews Dr. Cindy Ivanhoe, director of the Spasticity and Associated Syndromes of Movement (SPASM) program at TIRR Memorial Hermann. Dr. Ivanhoe shares her journey in PM&R, expanding on her passion for brain injury and spasticity management. Dr. Ivanhoe emphasizes the value of a multidisciplinary approach and offers valuable insights for aspiring physiatrists and medical students. Tune in for an inspiring conversation that blends knowledge and compassion in healthcare! Don't forget to leave a review and share what topics you'd like us to cover next. Website: www.aocpmr.org Instagram: @aocpmr Youtube: @AOCPMR

Listen in to Research Perch as MTF President Adrienne F. Asta speaks with Spencer Pon, Gold Winner of MTF's 2023 Student Case Report Contest, about his winning case report, Massage Therapy for Ankle Mobility and Spasticity in an Adult with Cerebral Palsy: A Case Report. Pon's research focused on the effectiveness of massage therapy in increasing ankle mobility and decreasing spasticity in an adult with spastic cerebral palsy (CP). Individuals with spastic CP commonly experience challenges such as increased deep tendon reflexes, tremors, and muscular hypertonicity. Through five massage therapy treatments administered over six weeks, Pon saw significant improvements in ankle mobility and a decrease in spasticity, offering promising insights into the potential benefits of massage therapy for individuals with CP.

Topics this episode are: Updates on my journey with Multiple Sclerosis, chest pain, MS hug, UTI, pain from heat, spasticity from cold and more. (I recorded this over a week ago so events are past but still prevalent). These are videos where I show my life and surroundings living with Multiple Sclerosis and talk about some MS related information or whatever I decide to talk about. I may talk about what is going on with me or look at stuff I get sent from people and companies and give my opinion about their thoughts and suggestions. I am not a doctor, check with a healthcare professional for any help you need. I am just giving my view of life with MS and talk about what I do but not giving advice for anyone to follow but me. Make sure your healthcare professional discusses any things you are thinking about trying out. Please give us a thumbs up, subscribe, rate, review, tell a friend, send questions and comments to kevintheduckpool@gmail.com and you can follow the Under the Cowl of MS podcast where you listen to your podcasts in which I talk about comic books, multiple sclerosis, video games, comic book readings, health and whatever comes to mind. #MS, #multiplesclerosis #mylife #mylifestyle #multiplesclerosisfighter #underthecowlofms #lymphedema #msneurologist #physicaltherapy #speech #uti #therapy #cooling #bladder #social #caretaker #nausea #heart #backpain #zinger #uti #spasticity #mshug #pain --- Support this podcast: https://podcasters.spotify.com/pod/show/kevin-kleinhans/support

I am very excited to talk about this topic because spasticity is one of those symptoms that is just, I think, the most frustrating and discouraging. One example is if you've noticed weakness from baclofen or weakness from botox when attempting to manage MS spasticity, this episode will explain why and give you MS exercises to help! There's lots of things that we can do to manage spasticity. So, let's dive in! Resources from this episode: The MSing Link Podcast - Episode 81 - Spotify / Apple The MSing Link Podcast - Episode 118 - Spotify / Apple The MSing Link Podcast - Episode 157 - Spotify / Apple The MSing Link Program Behind The Scenes Video Inside The MSing Link Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

On this week's episode we hosted a specialist in Physical Medicine and Rehabilitation, Dr. List and occupational therapist Briana Elson, MS, OTR/L, BCPR, CBIS to share insights on spasticity management, focusing on the use of neurotoxin injections and collaboration between physicians and therapists. Key discussion points included: When do you recommend medication versus injection for spasticity management? What do you consider when deciding on a treatment plan for someone with spasticity? What does botulinum toxin do versus what does it not do? When is it too early or too late for neurotoxin injections? Is there research showing that earlier treatment with neurotoxins can prevent symptoms from worsening? Are neurotoxins typically covered by insurance for people? How do you differentiate between spasticity and hypertonicity? What's the best way to get a good outcome when injecting for contractures? Do people need neurotoxin injections continuously to manage spasticity, or do some only need it temporarily? When do you decide that intrathecal baclofen might be necessary instead of injections? How do you respond to concerns about weakness from neurotoxin injections? Does neurotoxin treatment help with pain associated with spasticity? What's the best way for therapists to communicate with physicians about patient needs for spasticity management? Who can perform neurotoxin injections, and how can patients find a provider? This session highlighted the complexity of spasticity management and the need for a multidisciplinary approach. By combining medical interventions with therapy and ongoing assessment, we can help our patients achieve their functional goals and improve their quality of life.

Not too long ago, I asked my Instagram followers what they wanted a podcast episode on. And one topic that was repeated by multiple people was spasticity. But not only that, the difference between spasticity vs. muscle tightness. And there were also some people who wanted to learn about muscle spasms. So I'm going to throw that in here as well! Let's dive in! Mentioned Resources in this episode: The MSing Link- Episode 81 Apple Podcast & Spotify The MSing Link Episode 118 Apple Podcast & Spotify Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Join us this episode for a conversation with Dr. Sina Sangari of the Shirley Ryan AbilityLab for a conversation about the paper titled "Spasticity Predicts Motor Recovery for Patients with Subacute Motor Complete Spinal Cord Injury" published in the journal Annals of Neurology. Regardless of the functional implications of spasms, Dr. Sangari and his colleagues explain the prognostic value that spasticity, early after an acquired spinal cord injury, can have in predicting recovery of volitional motor function. We hope you enjoy this scholarly episode that offers a fresh take on the classic topic of spasticity.

Join us this episode for a conversation with Dr. Sina Sangari of the Shirley Ryan AbilityLab for a conversation about the paper titled "Spasticity Predicts Motor Recovery for Patients with Subacute Motor Complete Spinal Cord Injury" published in the journal Annals of Neurology. Regardless of the functional implications of spasms, Dr. Sangari and his colleagues explain the predictive value that spasticity, early after an acquired spinal cord injury, can have in predicting recovery of volitional motor function. We hope you enjoy this scholarly episode that offers a fresh take on the classic topic of spasticity.

Join us in this week's episode by welcoming back Dr. Gretchen Hawley, PT, creator of the MSing Link. With her broad knowledge and specialization in MS, we will dive deeper into her research, recent findings, and more.  This week we focus on:  How vibration and perturbation training increases proprioception and reduces the risk of falls. More research updates on treating spasticity. Aerobic exercise and its benefits on supporting neuroplasticity. The impact of treating comorbidities to improve overall health and how that can also help with MS symptoms. Tune in now and learn more about MS and stay up-to-date on the latest research! You can find Dr. Gretchen's work and website at www.doctorgretchawley.com

On today's episode, we talk about symptom management for spasticity in addition to the different types of spasticity and similar symptoms. This episode is chock full of his best recommendations for therapies and medications. Dr. Barry Singer is the director and founder of The MS Center for Innovations in Care at Missouri Baptist Medical Center. He is an Associate Professor of Clinical Neurology at Washington University School of Medicine. Dr. Singer earned his undergraduate degree from Duke University and his medical degree from Columbia University College of Physicians and Surgeons. He completed neurology residency at New York Hospital-Cornell University and a neuroimmunology fellowship at the National Institutes of Health. He has been an investigator in greater than 35 multiple sclerosis trials focused on new therapeutic options including remyelination. He serves on the Board of Directors of the Multiple Sclerosis Association of America since February 2016 and has a position on its executive committee. His award-winning MS patient education website www.mslivingwell.org started in 2007 has been a valuable resource in 200 countries. Dr. Singer is the host of the MS Living Well podcast. Dr. Barry Singer's website:https://www.mslivingwell.org/ MS Living Well with Barry Singer MD on Apple Podcasts HERE MS Living Well with Barry Singer MD on Spotify: https://open.spotify.com/show/6uIJrnioqBBzutks26bZth Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Wherever you are on your multiple sclerosis journey, there are many reasons to be optimistic about the future of mobility. Our experts, both holding doctorates in physical therapy, offer invaluable guidance on enhancing your walking abilities through targeted exercise and specialized therapy. Learn how to reduce the risk of falls, alleviate spasticity, and build endurance for a more active life. Cutting-edge technology, from wearable electrical stimulation devices to incredible exoskeletons, are revolutionizing mobility for those living with MS. Discover how neuromodulation, in conjunction with physical therapy, can pave the way for new neural pathways. Virtual reality and anti-gravity treadmills are redefining therapy options for those people with advanced MS. Moreover, gain insights into conquering travel challenges, empowering individuals living with multiple sclerosis to venture out into the world. Barry Singer MD, Director of The MS Innovations in Care, interviews Gretchen Hawley DPT, The MSing Link and Annie Morrow DPT, Director of the Stephen A. Orthwein Center.

Neuro rehabilitation specifically helps patients who have suffered from an event like a stroke or other neurological injury. First Physicians Group Physiatrist Ryan Hafner, MD specializes in spasticity management, and explains why seeking Neuro rehab early can help patients get back to their lives.You can also watch the video recording on our YouTube channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.

Spasticity can be present in many of the conditions we treat as occupational therapy professionals. And, it can add significant cost and burden for our patients. The article we are discussing in this 1-hour course gives you a big picture overview of the science behind what we know (and don't know!) about spasticity. You'll find certain approaches (that I've personally used!) that have NOT been supported by the research—but also which modalities have a growing body of evidence behind them. After reviewing the research, we'll be joined on the podcast by neuro OT, Scott Thompson, OTD, MOT, OTR/L, CRSR, LSVT-BIG to discuss implications for your practice! In order to earn credit for this course, you must take the test within the OT Potential Club.You can find more details on this course here:https://otpotential.com/ceu-podcast-courses/ot-spasticity-adultsHere's the primary research we are discussing:Khan, F., Amatya, B., Bensmail, D., & Yelnik, A. (2019). Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews. Annals of physical and rehabilitation medicine, 62(4), 265–273. Support the show

How burdensome is spasticity for patients with MS? What's the approach to treatment, and how effective is it? What do patients and clinicians need to know about cannabis-based therapies? These are the key questions Program Director Dr. Michael Kornberg from the Johns Hopkins School of Medicine discusses with guest MS spasticity experts in this second part of this eMultipleSclerosis Review Special Edition. Take our post-test to claim CME credits.To read a companion newsletter click here. Hosted on Acast. See acast.com/privacy for more information.

How burdensome is spasticity for patients with MS? What's the approach to treatment, and how effective is it? What do patients and clinicians need to know about cannabis-based therapies? These are the key questions Program Director Dr. Michael Kornberg from the Johns Hopkins School of Medicine discusses with guest MS spasticity experts in this second part of this eMultipleSclerosis Review Special Edition. Take our post-test to claim CME credits.To read a companion newsletter click here. Hosted on Acast. See acast.com/privacy for more information.

Episode 563 MS Monday episode in which we talk about Multiple Sclerosis stuff and whatever: Sugar Flush update, Eating Seasonally, Cheesecake, Low-Dose Naltrexone LDN, Spasticity. #MS, #MultipleSclerosis, #healthtalk, #MonSter, #brain Send comments, questions and tips to kevintheduckpool@gmail.com please help us out by rating and reviewing us and telling a friend.  Also check out audio and video versions of Crimson Cowl Comic Club & Under the Cowl podcasts. A fun variety of great people talk comic books, entertainment or whatever and you can see or hear me on many episodes of those podcasts as well with many more great episodes to come out in the future. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kevin-kleinhans/message Support this podcast: https://podcasters.spotify.com/pod/show/kevin-kleinhans/support

Episode 543 Multiple Sclerosis and Health episode in which we talk about: Parkinson's vs Multiple Sclerosis pt 2, Chronic Inflammation, Folic Acid, Parfaits that won't Spike Blood Sugars, Spasticity and Quality of Life. #MS, #MultipleSclerosis, #healthtalk, #MonSter I am not a doctor, always consult with your medical team before trying anything new or talked about. I just review and go over things I find or have been given. Send comments, questions and tips to kevintheduckpool@gmail.com please help us out by rating and reviewing us and telling a friend. Also check out audio and video versions of Under the Cowl of MS, Crimson Cowl Comic Club & Under the Cowl podcasts. A fun variety of great people talk comic books, entertainment or whatever and you can see or hear me on many episodes of those podcasts as well with many more great episodes to come out in the future. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kevin-kleinhans/message Support this podcast: https://podcasters.spotify.com/pod/show/kevin-kleinhans/support

On today's episode, we're diving into the ins and outs of spasticity. You'll finish this episode feeling prepared with actionable steps to improve your mobility and muscle tightness to improve your energy and therefore, do more in your daily life. Dr. Mitzi Joi Williams is a Board-Certified Neurologist and Fellowship trained Multiple Sclerosis Specialist who serves as the Founder & CEO of the Joi Life Wellness Group Multiple Sclerosis Center in Smyrna, GA. She is considered a subject matter expert in Neurology, Multiple Sclerosis, and Health Disparities. Dr. Williams has over 15 years of experience in the field of Multiple Sclerosis. She received her undergraduate degree in Neuroscience and Behavioral Biology from Emory University in Atlanta, GA, and received her Doctor of Medicine Degree from Morehouse School of Medicine also in Atlanta, Georgia. She completed her Internal Medicine Internship, Neurology Residency, and Multiple Sclerosis Fellowship at Georgia Health Sciences University (formerly MCG) in Augusta, GA, where she received numerous accolades and served as Chief Resident of the Neurology Residency Program. Connect with Dr. Mitzi: IG: @thenerdyneurologist FaceBook: @thenerdyneurologist LinkedIn: https://www.linkedin.com/in/drmitzijoimd/ Website: https://joilifewellness.com/ Book: https://www.amazon.com/You-Live-Well-Multiple-Sclerosis/dp/B0BSJ6DKTM/ref=sr_1_1?crid=30GV487RN869W&keywords=you+can+live+well+with+multiple+sclerosis&qid=1677878626&sprefix=You+Can+Live+Well+%2Caps%2C89&sr=8-1 Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Stroke survivors with physical deficits have to fight to get the muscles moving again. They also have to fight to stop some muscles from moving. Tone and spasticity are why our elbows curl, our fists squeeze tight, and our toes can curl under our feet so we crush our own toes as we walk. Dr. Wayne Feng is an expert in tone and spasticity after stroke and he joins us this week to explain how we can address these challenges If you don't see the audio player below, visit Strokecast.com/MSN/ToneBasics to listen to the conversation. Click here for a machine-generated transcript Who is Dr. Wayne Feng? From Dr. Feng's Duke Profile: I am the division chief for Stroke and Vascular Neurology in the Department of Neurology at Duke Health. I see stroke patient in the emergency department, inpatient service as well as in the outpatient clinic. I also treated post-stroke limb spasticity, a disabling complication after stroke. In addition to the patient care, I also run a brain modulation and stroke recovery lab at the Duke University campus to study stroke patients in my lab to develop new stroke recovery therapy. On my days off, my boys and I are big on fishing. I enjoy drinking and collecting tea. As a stroke doctor, I do not drink coffee at all (there is a reason for it). If you come to see, I will tell you. Current Appointments and Affiliations: Professor of Neurology, Neurology, Stroke and Vascular Neurology 2019 Chief of Stroke & Vascular Neurology in the Department of Neurology, Neurology, Stroke and Vascular Neurology 2019 Professor of Biomedical Engineering, Biomedical Engineering 2022 [youtube https://www.youtube.com/watch?v=SGeOGI2bry4&w=560&h=315] Tone and Spasticity Overview Mos of our limbs move because of the interaction between two types of muscles -- extensors and flexors. The flexors contract to bend a limb. The extensors contract to extend the limb. For example, the biceps are flexors. They pull our forearm up or into an angle. When people want to show off their arm muscle, the flex their arm -- they activate their flexors. The triceps on the back of the upper arm are extensors. When they activate, they extend the arm -- they pull the arm straight.  When flexors contract extensors relax. When extensors contract, flexors relax. That's how we control our limbs. After stroke, the flexors can activate on their own. And they can be, well, overenthusiastic, in those actions. That happens because the default behavior of the flexors is to be active and curl up. When we talk about curling up into the fetal position, that's most of our flexors activating. The reason we can go through life upright and with our limbs straight is that the cortex of the waking brain is constantly suppressing the normal contracting of the flexors. After stroke impacting the motor cortex of the brain, the corticospinal tract is disconnected. With that disconnect, the brain can no longer suppress the flexors so they do what they do -- they contract and curl and cause all sorts of problems. Peripheral vs Cortical Problems Categorizing issues as cortical or peripheral is a fancy way of saying brain or limb. A stroke is a cortical issue. The problem exists in the brain. That's where the disconnect happens. A peripheral issue is when something goes wrong in the limb. Shoulder subluxation, for example, is peripheral issue. Most PT and OT works with the limbs to treat the cortical issues. Tone and spasticity are caused by cortical issues. The long-term problems caused by tone and spasticity are peripheral issues. One of those peripheral issues is contracture. When tone and spasticity is severe and long term, the muscles, tendons, ligaments, and other soft tissue can actually shrink in the contracted position. When that happens, getting the extensors back online and suppressing the flexors no longer  helps. The limb can become almost permanently bent. Repairing peripheral issues, like contracture, may require surgery to sever and extend tendons and other tissue. Preventing and Treating Tone and Spasticity The first line of defense is in the immediate short-term after stroke. Getting the limbs moving and keeping them moving to drive the neuroplastic change of recovery helps. Beyond that, and once tone and spasticity set in, regular stretching is critical. A survivor needs to keep stretching those limbs to prevent contracture. That's why in conference calls and interviews, I'm often stretching my fingers back and my wrist back to counteract the tone and spasticity in my left arm and hand. Medication can help, too. Baclofen is a popular choice. It's basically a muscle relaxer that helps counteract the excessive action in my flexors. Some people find it can cause drowsiness so it's not the best choice for everyone. I tend to take my Baclofen before going to bed. If it makes me drowsy then that's great. It also helps reduce the tone I might experience overnight. For folks with severe tone and spasticity, a surgically implanted Baclofen pump can help. The medicine directly target the key muscles which means the patient needs much less medicine for a much greater impact. Since it is a low dose, it is less likely to induce the fatigue, too. Other medications to treat tone and spasticity include: Tizanidine Flexeril Gabapentin Botox, Dysport, and Xeomin are also treatments that can help. These are neurotoxins that a doctor can inject every three to four months. By delivering the toxins to the flexors, it reduces their ability to flex. That gives the extensors a chance to recover and rebuild a normal relationship. Of course, this is a short-term solution. Combined with exercise, it can definitely help. I'm probably overdue for my next Dysport treatment. Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery A promising area for relieving tone and spasticity is C7 nerve transfer. Recent studies are showing promising results. Neurosurgeons split the a nerve from the unaffected side of the brain that runs through the spine and reconnect half of it to the equivalent nerve on the affected side. The do this in the neck. Results show a quick reduction in tone and spasticity even in patients 15+ years after stroke. After a year, patients are experiencing improved use of the limb, too. The number of people in the studies so far is pretty small (36) and more research is needed. It is a promising result, though, and builds on techniques that have been used to treat non-stroke injuries. It also highlights the tremendous ability of the brain to adapt since now the unaffected side starts to control the affected side of the body. You can read a review of the technique and studies at the Journal of Clinical Medicine. Vagus Nerve Stimulation In 2021, I spoke with Dr. Jesse Dawson, a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital in Scotland about his research in Vagus Nerve Stimulation. This research is now being commercialized and used to treat patients in the US. The therapy involves surgically implanting a stimulator in a patient's chest that connects to the Vagus nerve. During PT or other exercises, the device sends an electric signal to the Vagus nerve. Stimulating the nerve while doing therapy has shown positive results in terms of limb use. It's interesting because it's not treating the Vagus nerve itself, but stimulating this nerve appears to make the other nerves in the brain more receptive to the therapeutic exercises. You can learn more about this research here: http://Strokecast.com/VNS. Survey What do you think of the Strokecast? Let me know what you like and what you would like to be different by completing the survey at http://Strokecast.com/Survey. I would really appreciate it. If you complete the survey by March 31, 2023, you could win a $25 Amazon gift card, too. Hack of the Week Hand grip exercisers are nice tools to encourage stretching and exercise throughout the day. These things are like a pair of pliers without the tool end. They are spring loaded. You squeeze them to exercise and they try to force your hand open. You can get them in a variety of strength levels. Start with light weight ones and move on to tougher ones as your strength improves. What I like about them is that closing a fist comes back before opening one. Closing your fist takes work. Opening your fist is often harder, but these gadgets force the hand open. So you get to practice the squeeze and you get a stretch into fingers, too, to address tone and spasticity. It's also one more way to reduce the odds of developing a contracture. Here are a couple options: https://strokecast.com/Hack/HandExerciserTraditional (Traditional design)* https://strokecast.com/Hack/HandExerciserAdjustable (Adjustable resistance)* Links Where do we go from here? Check out Dr. Feng's work at Duke University Share this episode with someone you know by giving them the link http://Strokecast.com/ToneBasics Complete the Strokecast survey at http://Strokecast.com/Survey Don't get best…get better More thoughts on Tone and Spasticity

Spasticity is one of the most common symptoms of MS, impacting up to 80% of the people living with MS. It can feel like mild muscle tightness that you wish would just go away or it can be so painful and debilitating that it keeps you from moving. Dr. Michelle Cameron joins me in this episode to discuss what spasticity is and how to best manage it. Dr. Cameron is a neurologist and physical therapist, a professor in the Department of Neurology at Oregon Health & Science University, Interim Chief of Neurology at the VA Portland Healthcare System, and Co-Director of the VA MS Center of Excellence West. We're also talking about a new framework for thinking and talking about MS that's been proposed by an international panel of MS experts. We'll tell you about a study that looked at polypharmacy and MS (Of course, we'll also tell you what polypharmacy is and why you should be aware of it!) We'll share the details around the discovery of human antibodies that have been shown to prevent Epstein-Barr infection (And we'll explain why this could be incredibly important) If you're an MS caregiver, or you know one, I'm asking for just 5 minutes of your time. We're celebrating National Caregivers Month by breaking down the details of the National Family Caregiving Strategy that was recently submitted to Congress. And we're celebrating the indomitable quality of the human spirit by sharing the story of Eric Domingo Roldan and his mom, Sylvia. We have a lot to talk about! Are you ready for RealTalk MS??! Thanksgiving is two days away!  :22 This Week: Managing Spasticity  1:02 Experts propose a new framework for thinking about and talking about MS  2:07 Polypharmacy and MS  5:55 Researchers identify antibodies that prevent Epstein-Barr Virus infection  9:02 If you're an MS caregiver, or you know one, can I have 5 minutes of your time?  11:30 The 2022 National Family Caregivig Strategy   13:55 Eric Domingo Roldan and his mom, Sylvia, make it into the Guinness Book of World Records  16:34 Dr. Michelle Cameron discusses spasticity and MS 18:40 Share this episode  33:55 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/273 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com Multiple Sclerosis Progression: Time for a New Mechanism-Driven Frameworkhttps://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00289-7/fulltext Tremlett's MS Research Explained: Polypharmacy and Multiple Sclerosis: A Population-Based Study https://tremlettsmsresearchexplained.wordpress.com/2022/10/27/polypharmacy-and-multiple-sclerosis-a-population-based-study/ STUDY: Polypharmacy and Multiple Sclerosis: A Population-Based Study https://journals.sagepub.com/doi/full/10.1177/13524585221122207 RealTalk MS Episode 229: Evidence Shows MS Is Triggered by the Epstein-Barr Virus with Dr. Kassandra Munger and Dr. AJ Joshi https://realtalkms.com/229 RealTalk MS Episode 231: Evidence Shows EBV Triggers MS: Understanding the Impact of this Breakthrough Research with Dr. Bruce Bebo https://realtalkms.com/231 STUDY: Epstein-Barr Virus gH/gL Has Multiple Sites of Vulnerability for Virus Neutralization and Fusion Inhibition https://cell.com/immunity/fulltext/S1074-7613(22)00544-1 Take the iConquer MS Caregiver Survey https://realtalkms.com/caregiver 2022 National Strategy to Support Family Caregivers https://acl.gov/sites/default/files/RAISE_SGRG/NatlStrategyToSupportFamilyCaregivers.pdf Eric Domingo Roldan's Instagram Handle @eeRiicbcn Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 273 Guest: Dr. Michelle Cameron Tags: MS, MultipleSclerosis, MSResearch, MSSociety, RealTalkMS Privacy Policy

Any injury or illness that affects the spinal cord can cause spasticity, an increase in muscle stiffness that can lead to immobility. Bobby Brunner, MD, a physiatrist, discusses some common disorders that result in spasticity and the wide spectrum of its severity. He walks us through the considerations a physiatrist would make in determining how to address spasticity. Dr. Brunner discusses a progression of treatment options for spasticity: physical therapy, injection therapies, pump system implantation, and surgery.

Interview with Dr. Edelle Field-Fote about her group's paper “ Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers” published in Archives of Physical Medicine and Rehabilitation in 2022.   Join DiSCIS hosts Kristen Cezat, PT, DPT, NCS and Uzair Hammad, PT, DPT as we learn more about this new and exciting work! For the transcript of the podcast click here. The Spinal Cord Injury Special Interest Group is part of the Academy of Neurologic Physical Therapy – www.neuropt.org

Before sitting down to record this episode, I asked The MSing Link members as well as those in my public MS support Facebook page what topic they would like to hear more about. And there was a resounding response to know more about spasticity! So, join me today as I share with you what it is exactly, different techniques you can do at home to reduce it, and different ways your neurologist may approach treatment. Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: Gretchen@DoctorGretchenHawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Brain Chat welcomes Dr. Mitzi's amazing mentor Dr. Mary Hughes and another super friend Dr. Jacqueline Nicholas to this episode to discuss spasticity. They talk muscle tightness, cramps, and what causes them, but most importantly what you can do about it!

This week Dr. Gretchen sits down with MSing Link member Jeanette! Jeanette has seen great improvements by being a part of the program, but also had some very relatable questions when it came to things such as spasticity, MS progression, and walking on uneven surfaces. Tune in to hear Dr. Gretchen answer Jeanette's questions and provide strategies on how to not only conquer situations such as uneven surfaces, but also how to see improvements! Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: Gretchen@DoctorGretchenHawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Dr. GG deFiebre of SRNA was joined by Dr. Miguel Escalón for an Ask the Expert podcast on "Managing Spasticity with a Baclofen Pump." Dr. Escalón began by giving an overview of spasticity, tone, and treatment options. He explained how the baclofen pump works, its advantages, and the impact on neurogenic bladder and bowel function. Next, Dr. Escalón described the initial surgical procedure, recovery process, and potential risks. Finally, he discussed long-term operation and maintenance, as well as safety measures and how pregnancy might impact the baclofen pump.